Meningococcus

Rev Neurol (Paris), 1992, 148(3), 237 - 8
{Recurrent Neisseria meningitidis meningitis associated with homozygote complement C7 fraction deficiency}; Angibaud G et al.; A 20-year old man had three episodes of meningococcal meningitis . Complement assays showed a complete deficiency of the seventh component of the complement system . This case emphasizes the need to perform complement assays in young patients with recurrent bacterial meningitis.

Bull Pan Am Health Organ, 1992, 26(1), 95 - 6
New children's vaccine initiative launched; ELISA test for antimeningococcal IgG and IgM antibodies: application to epidemiology and diagnosis; Department of Medical Microbiology, University Hospital Tromso, NorwayWe have developed an enzyme-linked immunosorbent assay (ELISA) in order to quantitate antimeningococcal IgM and IgG serum antibodies . The B:15 meningococcal strain was used as coating antigen, and class specific antibodies were detected by using alkaline phosphatase labelled rabbit anti-human IgM or IgG as conjugate . The specific IgG activity was higher in sera from healthy meningococcal carriers than non-carriers, but the difference was not statistically significant . Antimeningococcal IgM serum antibodies were more frequent in carriers that in non-carriers . Acute sera from 34 patients with fulminant meningococcal disease contained less specific IgG and had a higher prevalence of IgM than healthy carriers and non-carriers . By combining measurement of antimeningococcal IgG and IgM antibodies in both acute and convalescent sera 15/18 meningococcal patients demonstrated an increase in either IgG and IgM antibodies during the hospital stay, giving a sensitivity of 83% . 8/118 individuals without meningococcal disease had detectable specific IgM antibodies in their serum, giving a clinical specificity of the test of 93% . We conclude that quantitation of specific IgG antimeningococcal antibodies by a whole bacteria ELISA test may be a useful test for the study of immunity against meningococcal disease in single individuals as well as in epidemiological studies . The combined use of the IgG and IgM tests is helpful in the diagnosis of meningococcal disease when blood or cerebrospinal fluid cultures are negative.

Eur J Epidemiol, 1992 Jan, 8(1), 114 - 6
Meningococcal disease in Italy in 1989; Stroffolini T et al.; Meningococcal disease in Italy decreased by 13.4% from 1988 to 1989 . The incidence rate was 0.5/100,000 in the general population and 1.3/100,000 in army recruits . The highest proportion of cases (27%) was seen in subjects 5-14 years old . The sex ratio was 1.3 . Forty-four percent of the isolates belonged to serogroup B; 37% belonged to group C . Forty-six percent of the strains were resistant to sulphonamides and 10% were resistant to minocycline; only 4% were resistant to rifampicin . None of the four military cases observed could be attributed to vaccine failure . One secondary case and no coprimary cases were observed among civilians . The shift in prevalence from serogroup C to serogroup B isolates is the most important finding of this study.

Ethiop Med J, 1992 Jan, 30(1), 33 - 6
Nasopharyngeal carriage of Neisseria meningitidis among school children at Ijede, Lagos State, Nigeria; Odugbemi T et al.; A total of 639 school children ranging in age from 5 to 15 years were investigated for nasopharyngeal carriage of Neisseria meningitidis in Ijede, Lagos-State, Nigeria . The carriage rate was found to be 6.2% . Of the 40 children from whom meningococci were isolated, 25 (62.5%) were males and 15 (37.5%) were females . Serogrouping of the isolates showed that serogroup C Neisseria meningitidis was isolated with the highest frequency 40%, while serogroups A, B, and W135 had isolation rates of 25.5%, 17.5% and 7.5% respectively . This study has shown that group C Neisseria meningitidis is the prevalent serogroup among school children in the area, which is south of the meningitis belt in Nigeria.

Microb Pathog, 1992 Jan, 12(1), 19 - 26
Anti-idiotype induced protection against Neisseria meningitidis serogroup C bacteremia; Westerink MA et al.; We have developed a monoclonal anti-idiotypic antibody, designated 6F9, which acts as the surrogate image of the meningococcal group C capsular polysaccharide (MCP) . Murine immunization with 6F9 results in a T-dependent anti-MCP antibody response . To examine the protective nature of the antibody response elicited by 6F9 we performed a series of live challenge studies using a murine model for meningococcal infection in which mice were iron dextran treated and challenged with 10 x LD50 of meningococcal group C strain 35E . Adult BALB/c mice immunized with 6F9 had a 100% survival and a significantly reduced level of bacteremia at 24 h . Mice immunized with MCP had an 80% survival rate, all survivors were bacteremic at 24 h . Neonatal mice primed within 24 h of birth and immunized at 4 weeks of age with 6F9 had a 100% survival and cleared their bacteremia by 8 h, which was significantly faster than the MCP primed and immunized mice . Neonatal mice primed with 6F9 and challenged at 5 weeks of age had a survival rate of 90% which was significantly higher than mice primed with MCP and the control group (60% and 50% survival, respectively) . Mice primed at birth and immunized at 8 days had a 100% survival and 90% of these mice had sterile blood cultures by 8 h . Mice primed and immunized with MCP all remained bacteremic at 24 h . These data indicate that the anti-Id 6F9 which mimics the capsular polysaccharide of group C meningococci is capable of inducing protective immunity in immunologically mature as well as immature animals.

Immunodefic Rev, 1992, 3(2), 123 - 47
Inherited deficiencies of the terminal components of human complement; Wurzner R et al.; The particularly frequent occurrence of terminal complement deficiencies in patients with Neisserial infections suggests that the cytolytic activity of the complement system is important in resistance to Neisseria meningitidis . There are, however, geographical differences in the prevalence of terminal complement deficiency in patients with meningococcal disease . The data available suggest that either recurrent infection or infection with uncommon serogroups should alert the clinician in Western countries whereas recurrent disease is the important indicator in high risk endemic or epidemic areas . An association of terminal complement deficiencies with susceptibility to autoimmune diseases or non-Neisserial infections is doubtful . For a better understanding of complement deficiencies in relation to disease more accurate characterization of the defects involved will be helpful . Sensitive ELISA techniques and molecular biological assays will be needed . Thus it has been established that two types of deficiencies exist (at least for C6, C7 and C8): one with low but detectable amounts of the component and the other with a complete absence of the protein in question . The subtotal variety appears to show less association with Neisserial infection . Low amounts of functional terminal complement activity may be sufficient for many of its biological functions, suggesting that there is a wide "safety margin".

Immunology, 1992 Jan, 75(1), 10 - 6
Properties of a low molecular weight complement component C6 found in human subjects with subtotal C6 deficiency; Orren A et al.; A sensitive ELISA assay was used to quantitate serum complement component C6 concentrations . Levels in the range 0.3-3 micrograms/ml were measured in samples from eight individuals (four separate pedigrees) and two subjects with subtotal combined C6/C7 deficiency who have been reported previously . We defined C6 levels in this range as subtotal C6 deficiency (C6SD) . In contrast, C6 deficiency with levels below 0.03 micrograms/ml was defined as C6Q0 . C6Q0 has been found in 29 unrelated cases which have already been reported . Investigations of the properties of the C6 found in the C6SD subjects showed it to be haemolytically active and able to incorporate into the terminal complement complex . The protein had a relative molecular weight (Mr) of approximately 86% of normal C6 and this Mr was identical to that of the C6 of one combined deficient subject . The Mr of the C6 of the other combined deficient subject was previously estimated as 79% of the Mr of normal C6 . Isoelectric focusing (IEF) analysis with band development by haemolytic overlay revealed that all C6SD samples produced an identical weak C6 band pattern anodal to normal C6A bands . The C7 IEF patterns of the two combined deficient subjects were identical, and the C6 IEF patterns of both were identical to those of the C6SD subjects . Thus the C6 of the combined deficient subjects is probably the same abnormal protein found in the C6SD individuals . None of the C6SD or combined deficient subjects have had meningococcal disease and it may be that low C6 levels afford some protection.

Vaccine, 1992, 10(10), 691 - 8
Development and phase 1 clinical testing of a conjugate vaccine against meningococcus A and C; Costantino P et al.; A conjugate vaccine against meningococcus A and C was prepared using the non-toxic mutant of diphtheria toxin CRM 197 as a carrier protein . Capsular polysaccharides of Neisseria meningitidis group A and C were hydrolysed and the resulting oligosaccharides were then coupled to CRM 197 in order to obtain conjugates with a carbohydrate content of 25-30% . The final vaccine that contained 11 micrograms of each oligosaccharide and 88 micrograms of CRM 197 was used to immunize mice and rabbits . After the preclinical studies which showed that the vaccine was safe and immunogenic in animal models, a pilot phase 1 clinical trial, blind versus placebo, was performed on adult volunteers . The difference between the incidence of adverse reactions associated with vaccine and placebo administration was not statistically significant . All the volunteers who received the vaccine had a significant increase in antibodies to group A and C meningococcal capsular polysaccharides after the first dose.

Scand J Infect Dis, 1992, 24(3), 333 - 8
Incidence, serogroups and case-fatality rate of invasive meningococcal infections in a Swedish region 1975-1989; Berg S et al.; In a retrospective study of invasive meningococcal infections in Greater Gothenburg, Sweden, 213 cases of culture-verified meningitis or septicaemia were identified during the 15-year period 1975-1989 . The annual incidence was 2.0/100,000 . Cases were seen in all age-groups with the highest rates in the 0-4 and 15-19 year-old groups, 9.5 and 6.2/100,000 respectively . 20% of the patients were less than 2 years . 91% of the patients had no known risk factors . In only 10 cases (5%) was contact with another case of meningococcal infection known . The main clinical manifestations were meningitis (57%), septicaemia with no sign of focal infection (25%) and septic shock (17%) . The case-fatality rate for all the patients was 6.6% and did not change during the 15-year period . One-third of the patients who presented with septic shock died . The serogroup was known for strains from 192 patients . 51% of the strains belonged to serogroup B, 10% to group A and 23% to group C . In conclusion, the incidence of meningococcal infection was low but the relatively high case-fatality rate warrants a search for effective prophylaxis . About 30% of the cases were potentially preventable by the currently available tetravalent (A, C, Y and W135) polysaccharide vaccine, which is immunogenic in children greater than 2 years . Widespread use of antibiotic prophylaxis to close contacts of known cases would not lower the incidence markedly.

Zh Mikrobiol Epidemiol Immunobiol, 1992, (7-8), 30 - 4
{The antibody response of animals to a corpuscular meningococcal group-B preparation with different methods of immunization}; Aleksakhina NN et al.; As revealed in animal experiments, the formation of antibodies to group-B N . meningitidis antigens (group-specific polysaccharide, lipopolysaccharide and outer membrane proteins) in response to administration of meningococcal corpuscular preparations depends on the method of administration, the dose, and the number of administrations . In the sera of rabbits, immunized orally, antibodies to all three antigens in sufficiently high titers have been detected.

Zh Mikrobiol Epidemiol Immunobiol, 1992, (5-6), 37 - 41
{The type subtyping of meningococci by means of whole-cell immunoenzyme analysis}; Demina AA et al.; In this work the method of the whole-cell enzyme immunoassay, used for the serotype-subtyping of meningococci by means of specific monoclonal antibodies, is described . High specificity of the method, the simplicity of the assay procedure and evaluation of its results, as well as the availability of this method for practical use, have been demonstrated . The results of this investigation confirm the importance of the evaluation of type-subtype appurtenance of reference and laboratory strains used in experiments . Study of 72 meningococcal strains obtained from patients has revealed their polyclonal character in respect of their type-subtype signs.

Ann Trop Paediatr, 1992, 12(2), 149 - 54
Prognostic factors influencing mortality in meningococcal meningitis; Fakhir S et al.; The clinical features and some laboratory parameters of 247 cases of meningococcal meningitis admitted between January 1983 and April 1990 to a paediatric ward in Jawahar Lal Nehru Medical College Hospital, India were analyzed retrospectively . A total of 189 (76.5%) were more than 5 years of age . The maximum number of cases occurred between October and April each year . Complications included bleeding tendencies, neurological deficits, gangrene of limbs, arthritis, uveitis and cataract . The overall mortality rate was 16% . A scoring system based on some clinical characteristics correctly predicted a fatal outcome in all but three children.

Vaccine, 1992, 10(3), 159 - 63
Murine cross-reactive T-cell epitopes of Neisseria meningitidis outer membrane proteins; Lifely MR et al.; Five non-covalent vaccines of outer membrane proteins (OMPs) complexed to capsular polysaccharide were prepared from Neisseria meningitidis serogroup B strains . Each vaccine contained distinct serotype (class 2/3) and subtype (class 1) OMPs . The cross-reactivity of the T-cell response to the meningococcal vaccine-associated proteins was examined in an in vitro T-cell proliferative assay, following antigenic priming of mice with one of these vaccines (MB6:P1.6) or with its purified class 1 (subtype P1.6) and class 2 (serotype 6) proteins . Cross-reactive T-cell epitopes were found in all five vaccine preparations on both the class 1 and class 2/3 OMPs . Priming of mice with the subtype P1.6 N-terminal peptide led to a significant but small increase in T-cell proliferation with the MB6:P1.6 vaccine.

J Infect Dis, 1992 Jan, 165(1), 53 - 68
A comparison of the variable antigens expressed by clone IV-1 and subgroup III of Neisseria meningitidis serogroup A; Achtman M et al.; Serogroup A Neisseria meningitidis of subgroup III has caused two pandemics of meningococcal meningitis since 1966 and recently spread to East Africa . The last epidemics in West Africa in the early 1980s were caused by clone IV-1 . Surface antigens of clone IV-1 strains from West Africa and subgroup III strains from both pandemic waves were analyzed . Lipopolysaccharide was stable within clone IV-1 but variable in subgroup III . Pili from clone IV-1 possessed class I epitopes, while those from subgroup III also possessed class IIa epitopes . Certain class 5 protein variants were expressed by both bacterial clones, possibly reflecting either inheritance of primeval genes or horizontal transmission . Exposure of Gambians to clone IV-1 bacteria stimulated production of bactericidal antibodies cross-reactive with subgroup III bacteria in some individuals but of type-specific antibodies in others . Gambians without bactericidal antibodies usually became healthy carriers rather than developing meningococcal disease on exposure to virulent meningococci.

Zh Nevropatol Psikhiatr Im S S Korsakova, 1992, 92(2), 39 - 41
{Status of cellular immunity in viral, serous and meningococcal meningitis}; Zaplotnaia AA; The paper is concerned with the immunological status of 62 patients with meningococcal and viral serous meningitides . A noticeable inhibition of cellular immunity, more pronounced in the CSF was detected . A correlation was shown to exist between the level of humoral factors that block T lymphocyte receptors in the CSF and the disease gravity.

Scand J Infect Dis, 1992, 24(3), 323 - 32
DNA fingerprinting in the epidemiology of African serogroup A Neisseria meningitidis; Bjorvatn B et al.; The restriction endonuclease (RE) technique was used to compare 172 meningococcal group A strains collected between 1969 and 1990, mainly from countries of the so-called African Meningitis Belt, the Gambia and Ethiopia . The 64 strains from various African countries (Niger, Chad, Burkina Faso, Cameroon, Morocco, Djibouti) were distributed within 3 main restriction enzyme patterns (REPs); the 77 Gambian strains fell into 5 REPs and the 24 Ethiopian strains into 2 such patterns . Several of the main REPs were formed by clusters of closely related clones . Clones, very similar to dominating REPs of the 1960s in Niger, Burkina Faso and Cameroon, were in the 1980s found to be strongly represented in the Gambia to the extreme west of the Meningitis Belt . One of the Gambian clones from 1983-86 was identical to an Indian clone recovered in New Delhi 1986-87 . Another clone was detected in 1983 in the Gambia, in 1989 again in the Gambia as well as in Ethiopia, and in 1990 in Tanzania . Our results are largely in line with those of previous studies based on modern techniques of protein and isoenzyme electrophoresis . The RE method is useful mainly for the exact genotypic differentiation of closely related clones, and seems to be a valuable complement to phenotypic tools for epidemiological mapping of Group A meningococcal infection.

Zh Mikrobiol Epidemiol Immunobiol, 1992, (11-12), 27 - 30
{The evolution of meningococcal infection in Mongolia}; Tsend N et al.; On the basis of the generalization and analysis of the results of bacteriological and immunological investigations the epidemic process of meningococcal infection (MI) in Mongolia was found to undergo definite changes during the last 20 years . Group A meningococci prevailing in the etiology of MI were replaced by strains belonging to group B affecting mainly young children (aged up to 3 years) . MI morbidity rate caused by group B meningococci was found to be higher in Mongolia than in other countries of the world . These data substantiate the necessity of using more effective remedies for the control of this infection and, in particular, specific immunization with vaccines against group B meningococci; profound study of the properties of the circulating meningococcal strains is to be carried out.

Ann Med Interne (Paris), 1992, 143 Suppl 1, 13 - 6
Removal of circulating tumor necrosis factor . Its role in septic shock treatment; Janbon B et al.; The tumor necrosis factor (TNF) is a polypeptide secreted by macrophages in response to endotoxins, especially from Gram-negative bacteria . Previous investigations suggest that TNF plays a prominent role in septic shock and meningococcal disease toxicity . A positive correlation was found between the initial serum TNF level and the patient's outcome . Despite the progress made in intensive care management and antibiotic therapy, the prognosis of septic shock remains very poor . Because of the implication of TNF in the pathogenesis of septic shock, we suggest that neutralization or elimination of this cytokine by plasma or blood exchanges could contribute to the treatment of severe forms of this syndrome . Five plasma exchanges and two blood exchanges were performed in 6 patients admitted for septic shock or purpura fulminans . Serum TNF levels were measured by immunoradiometric assay (Medgenix, ERIA Pasteur) before and after exchange . Serum TNF levels were found to be decreased by an average of 62% after the exchange . We conclude that exchange therapies are efficient in removing plasma TNF . Nevertheless, because of the limited number of patients treated, it is not possible to evaluate the clinical efficacy of such techniques.

Ugeskr Laeger, 1991 Dec 16, 153(51), 3613 - 4
{Chronic meningococcemia . A review and a report of 4 cases}; Rasmussen LH et al.; Four cases of chronic meningococcacemia (CM) are described . The diagnosis was based on recurring fever, exanthema, arthralgia/arthritis and positive blood culture with Neisseria meningitidis . The meningococcal antibody-test (MAT) was positive in all of the three patients tested . None of the patients had positive throat culture for Neisseria meningitidis . All patients had leucocytosis during the febrile periods . The symptoms lasted for 5-150 days before the diagnosis was made . These findings are discussed in relation to the literature.

Infect Immun, 1991 Dec, 59(12), 4349 - 56
Specificity of antibodies to O-acetyl-positive and O-acetyl-negative group C meningococcal polysaccharides in sera from vaccinees and carriers; Arakere G et al.; Most group C Neisseria meningitidis strains produce an O-acetyl-positive polysaccharide, a homopolymer of alpha-2----9-linked N-acetylneuraminic acid with O-acetyl groups at the C-7 and C-8 of its sialic acid residues . The majority of disease isolates have been reported to contain this polysaccharide . Some strains produce group C polysaccharide lacking O-acetyl groups . The licensed vaccine contains the O-acetyl-positive polysaccharide . We have measured the antibody specificities to the two polysaccharides in sera from asymptomatic group C meningococcal carriers and vaccinated adults by a new enzyme-linked immunosorbent assay (ELISA) procedure using methylated human serum albumin for coating the group C polysaccharide onto microtiter plates . Inhibition of binding of serum antibodies to polysaccharide-coated plates was measured by ELISA after incubation with O-acetyl-positive and O-acetyl-negative group C polysaccharides . Greater inhibition of binding of carrier sera was observed with the homologous polysaccharide . There was substantial inhibition of binding of vaccinee sera to the O-acetyl-positive polysaccharide-coated plate following preincubation with O-acetyl-positive polysaccharide, but homologous inhibition on plates coated with the O-acetyl-negative polysaccharide required much higher concentrations of polysaccharide . Carrier sera may have a higher proportion of antibodies with greater specificity for the O-acetyl-negative polysaccharide, while vaccinee sera contain antibodies with greater affinity for the O-acetyl-positive polysaccharide . Studies with monoclonal antibodies specific for O-acetyl-positive and O-acetyl-negative polysaccharides reveal that the percentage of group C meningococcal disease caused by O-acetyl-negative strains remains about 15%, as found over 15 years ago.

NIPH Ann, 1991 Dec, 14(2), 95 - 101; discussion 101-2
The Norwegian meningococcal group B outer membrane vesicle vaccine: side effects in phase II trials; Nokleby H et al.; In order to establish the safety of the Norwegian meningococcus B vaccine we have focused on detailed reporting of side effects in several phase II trials . We report here the results of the largest single phase II study, (step II-6) including 877 school children . The incidence of local side effects was significantly higher in the vaccine than in the placebo group, but most of them were mild and short-lasting . Mild systemic side effects were commonly reported in both groups, but more severe side effects were rare and almost equally distributed between the groups.

NIPH Ann, 1991 Dec, 14(2), 81 - 91; discussion 91-3
Design of clinical trials with an outer membrane vesicle vaccine against systemic serogroup B meningococcal disease in Norway; Bjune G et al.; An outer membrane vesicle vaccine against acute, systemic disease caused by meningococci of serogroup B has been developed . The vaccine has been tested consecutively in phase I and phase II clinical trials including more than 5000 volunteers . These trials provided data on safety, immunogenicity and reactogenicity and possible effect on carriage of meningococci in the throat, and consequently formed the basis for two major protection trials; one in secondary school students and one among military recruits . The aims, design and major results of phase I and phase II studies are described as well as the design and organization of the protection trials.

NIPH Ann, 1991 Dec, 14(2), 67 - 79; discussion 79-80
Production, characterization and control of MenB-vaccine "Folkehelsa": an outer membrane vesicle vaccine against group B meningococcal disease; Fredriksen JH et al.; A vaccine against serogroup B meningococcal disease has been prepared from a B:15:P1.7,16 meningococcal strain (44/76) by fermentor growth and extraction of the bacteria with the detergent deoxycholate . Outer membrane vesicles (OMV) were purified by ultracentrifugation and adsorbed to aluminium hydroxide adjuvant . OMV contained the major class 1, 3, 4 and 5 proteins and some minor high molecular weight protein components . Relative to protein, the vaccine also contained about 8% phospholipid, 7% lipopolysaccharide and 16% deoxycholate . The product was generally non-pyrogenic to humans in ordinary doses and was highly immunogenic in mice and humans . Production and control steps, physical, chemical and immunological data for the vaccine are described.

NIPH Ann, 1991 Dec, 14(2), 57 - 65; discussion 65-6
The epidemiology of meningococcal disease in Norway 1975-91; Lystad A et al.; The epidemiology of meningococcal disease (MCd) in Norway is described on the basis of official notification figures for 1975-91 . Morbidity is presented by serogroup of the isolated Neisseria meningitidis strain, time of onset of the disease in addition to the place of living, age and sex of the patient . A long-term group B epidemic with high incidence and case fatality rates in the age groups below 5 years and between 13 and 19-20 years is the main characteristics of the situation.

NIPH Ann, 1991 Dec, 14(2), 225 - 30; discussion 230-1
Development of a second generation group B meningococcal vaccine; Frasch CE et al.; Outer membrane protein vaccines have now been demonstrated to be effective in prevention of group B Neisseria meningitidis disease, but the extent and duration of protection needs improvement . To develop a second generation outer membrane protein vaccine we have begun studies to evaluate vaccines containing iron regulated proteins in lipopolysaccharide depleted outer membrane vesicles . Since the iron regulated proteins are critical for in vivo survival, it is our working hypothesis that antibodies to these proteins will either be bactericidal or block iron uptake . Four representative strains were selected, and preliminary studies indicate that vaccines containing the iron regulated proteins are immunogenic in mice.

NIPH Ann, 1991 Dec, 14(2), 219 - 21; discussion 222-4
Vaccine efficacy determination; Broome CV; The "Gold standard" in vaccine testing is the randomized, placebo controlled, double-blind efficacy trial . Once a protective immune mechanism is defined, e.g., from an efficacy trial, vaccine performance can then be judged by serologic parameters . Although immunogenicity studies can provide important information, in many instances the answer has to come from efficacy trials . For rare diseases like meningococcal disease, these trials are expensive and difficult to conduct . It is therefore incumbent to learn as much as possible from each trial . Issues in pre-licensure studies include: vaccine selection, site selection, trial design, assignment to treatment and control groups, definition and surveillance for endpoints (cases, adverse reactions), identification of surrogate markers for protection, and utilization of monitoring committees.

NIPH Ann, 1991 Dec, 14(2), 195 - 207; discussion 208-10
Vaccine against group B Neisseria meningitidis: protection trial and mass vaccination results in Cuba; Sierra GV et al.; The Cuban vaccine, first in the world with proven efficacy against group B-caused disease, is based on outer membrane proteins from B meningococci capable of inducing long-lasting and high-titered bactericidal antibodies in humans . This bactericidal activity has a wide spectrum against all pathogenic group B Neisseria meningitidis tested . A randomized, double-blind controlled trial of the vaccine efficacy was performed during 1987-1989 with 106,000 10-14 years old students from 197 boarding schools in seven provinces . The efficacy obtained was 83% (chi 2, p less than 0.002; Fischer exact, p less than 0.001) . In a second field trial including 133,600 persons from 5 months to 24 years of age in Ciego de Avila province (30 cases/10(5) inhabitants, the highest incidence rate in Cuba) by comparing vaccinated and non-vaccinated population after 2.5 years of observation and careful follow-up, the efficacy and safety was confirmed . Because of these results and because of the very low reactogenicity of the vaccine, the Ministry of Public Health took the advice of the Scientific Council to vaccinate all children between 3 months and 6 years of age in the most affected provinces . No severe or long lasting reactions to the vaccine were observed after the millions of doses administered . The efficacy of vaccination varied in the provinces between 83% and 94%, among age groups ranging from 3 months and 20 years . After 3 years of massive application no severe reactions occurred and one of the most severe epidemics has been practically eradicated.

NIPH Ann, 1991 Dec, 14(2), 157 - 65; discussion 166-7
Serum opsonins to serogroup B meningococci after disease and vaccination; Halstensen A et al.; In this review the results of three previous studies are compared and discussed . Sera from 101 patients with meningococcal disease and from 113 volunteers immunized twice with vaccine preparations against serogroup B meningococci were examined for antimeningococcal opsonic activity using a chemiluminescence (CL) method . Twelve groups of vaccinees were immunized twice with one of four different doses of an outer membrane vesicle (OMV) preparation either alone or complexed to serogroup C polysaccharide and/or the adjuvant Al(OH)3 . The OMV vaccine strain (44/76) was a patient isolate characterized as B:15:P1.16 . The 89 surviving patients and 97/113 volunteers responded with significantly increased opsonic activity to the vaccine strain . Sera from all vaccinees with low preimmunization levels demonstrated a significant postimmunization increase in opsonic activity . The vaccine response was dose related, and the second injection induced a booster response in those who received preparations containing Al(OH)3 . At 26 weeks a reduction in opsonic activity to preimmunization levels was noted in 19/97 previous responders . The reduction was less pronounced in those who were immunized with the higher doses . Using CL and flow cytometry we found vaccinee sera to show cross reacting opsonin responses to other serogroups and serotypes of meningococci except meningococci of serotype 2a and 2b . The increase in antimeningococcal opsonins after vaccination suggests that the serogroup B OMV vaccine may induce protection against clinical disease.

NIPH Ann, 1991 Dec, 14(2), 147 - 55; discussion 155-6
Bactericidal antibodies after vaccination with the Norwegian meningococcal serogroup B outer membrane vesicle vaccine: a brief survey; Hoiby EA et al.; Results from the serum bactericidal assay (BA) after immunization of human volunteers with the Norwegian serogroup B meningococcal outer membrane vesicle vaccine are surveyed . In the phase II trials with adults we found very high seroconversion rates (greater than 98%) against the vaccine strain in the BA . Details in the antigenic composition of the inoculum used in the BA seem very important as shown here by finding lower bactericidal titres with teenager sera when tested with a variant of the standard inoculum . The present preliminary report corresponds to the presentation given at the Report Meeting on the Norwegian Meningococcal Vaccine Trial, Oslo, 12 September, 1991.

NIPH Ann, 1991 Dec, 14(2), 125 - 30; discussion 130-2
Results of an efficacy trial with an outer membrane vesicle vaccine against systemic serogroup B meningococcal disease in Norway; Bjune G et al.; A placebo controlled, double blind efficacy trial with a new outer membrane vesicle vaccine against systemic meningococcal disease of serogroup B, has been conducted in Norwegian secondary schools . The study was randomized at school level (1335 schools) and 171,800 students volunteered . The study started in October 1988 and the code was opened in June 1991 . Out of the thirty-six proven cases of acute, severe, systemic disease caused by serogroup B meningococci among the participants, twelve occurred in eleven schools given vaccine, twenty-four in twenty-four schools given placebo . twenty-four cases were recorded among secondary school students who did not participate in the study . The protection rate was calculated to 57.4% with a p-value of 1.2% and lower limit of confidence (95%) to 27.7% . The results have initiated research towards an improved outer membrane vesicle vaccine against this disease.

NIPH Ann, 1991 Dec, 14(2), 107 - 21; discussion 121-3
The Norwegian meningococcal serogroup B outer membrane vesicle vaccine protection trials: case tracing, meningococcal antigen detection and serological diagnosis; Hoiby EA et al.; A survey is given of the efforts made to inform the general public, the potential vaccinees and their parents, and the health care personnel about meningococcal disease in general and the vaccination trial in particular, as a preparation for the meningococcal outer membrane vesicle serogroup B vaccine (MenB-vaccine "Folkehelsa") trials in secondary school students and military conscripts in Norway . Our case reporting system, supplementing the official notification, concerning even vaguely suspected cases in the age cohorts involved, is described . The efforts made to collect clinical material as well as laboratory and clinical data from 221 registered suspected cases are delineated . We also briefly summarize our cerebrospinal fluid antigen detection methods and diagnostic meningococcal serology work on these suspected cases . The compiled information on findings done at the admitting hospital of the possible cases and the additional diagnostic data provided at the National Institute of Public Health were put at the disposal of the independent Diagnosis Review Committee (DRC) as a basis for their diagnostic decisions before code opening for the meningococcal serogroup B outer membrane vesicle vaccine protection trial 3 June 1991.

Microb Pathog, 1991 Dec, 11(6), 447 - 52
Blocking of bactericidal killing of Neisseria meningitidis by antibodies directed against class 4 outer membrane protein; Munkley A et al.; The class 4 protein of Neisseria meningitidis is a highly conserved outer membrane protein, closely related to the protein PIII of Neisseria gonorrhoea . Monoclonal antibodies SM50 and SM54 raised against PIII also react with class 4 protein but do not promote complement mediated bactericidal killing of meningococci . In addition, mAb SM50 inhibits the anti-meningococcal bactericidal activity both of normal human sera and of mAb SM300, directed against a protective epitope on the class 1 outer membrane protein . The ability of class 4 protein to induce such 'blocking' antibodies suggests that its presence in experimental vaccines, based on meningococcal outer membranes, may be antagonistic to the development of effective bactericidal immunity.

Am J Trop Med Hyg, 1991 Dec, 45(6), 676 - 82
Detection of IgM antibodies to Neisseria meningitidis group A polysaccharide in meningitis patients by direct and antibody capture enzyme-linked immunosorbent assays; Sippel JE et al.; Serum specimens obtained from culture-positive group A meningococcal meningitis patients in Cairo, Egypt were tested for immunoglobulin M (IgM) antibodies to Neisseria meningitidis group A polysaccharide by direct and IgM capture enzyme-linked immunosorbent assays (ELISAs) . Sera from patients with meningitis caused by other bacteria were used as negative control specimens . The IgM antibodies to this antigen were detected by direct ELISA in 93% of 58 specimens obtained from patients with group A meningococcal disease three or more days after hospital admission, and by IgM capture ELISA in 83% of 60 such specimens . Sixteen percent of 25 specimens obtained three or more days after admission from negative control patients were positive by direct ELISA, and 4% were positive by IgM capture ELISA . The correlation coefficient of the results with the two assays was 0.85.

J Trauma, 1991 Dec, 31(12), 1693 - 5
Posttraumatic meningococcal meningitis: case report; Stillwell M et al.; A case is described of fulminant meningococcal meningitis occurring 1 day after serious head and facial trauma . Although meningococcus is one of the most common causes of bacterial meningitis in general, it is distinctly rare as a cause of posttraumatic meningitis . A review of the literature is included.

NIPH Ann, 1991 Dec, 14(2), 169 - 79; discussion 180-1
Human antibody responses after vaccination with the Norwegian group B meningococcal outer membrane vesicle vaccine: results from ELISA studies; Rosenqvist E et al.; Antibody responses after vaccination with three different formulations of a new meningococcal group B outer membrane vesicle (OMV) vaccine have been studied with the ELISA technique using four different antigens . Sera from about 1200 vaccinees participating in steps 1, 2, 3 and 6 of the phase II clinical trials in Norway were analysed . The effects of non-covalently complexing the OMV antigen to group C polysaccharide (C-PS) and of adsorbing OMV (with and without C-PS) to aluminium hydroxide (AH) were studied . All three vaccine formulations were highly immunogenic in humans . Adsorption of the vaccine to AH had a relatively small effect on the immune response, but the results indicated that the booster response was stronger with the adsorbed than with the unadsorbed vaccines . Some increase in the immune response against OMV was also observed by non-covalent complexing OMV with C-PS, particularly after the second dose . In most of the vaccinees the antibody levels were significantly reduced 6 to 12 months after vaccination . Adsorption of the vaccine to AH had no effect on the antibody response against C-PS . Comparison with bactericidal activity of the same sera was done . A highly significant correlation was observed between the bactericidal titres and the levels of IgG antibodies against OMV and class 5C protein, whereas the correlation between antibody levels against lipopolysaccharide and the bactericidal activity was poor.

Med J Aust, 1991 Nov 18, 155(10), 713 - 4
Severe meningococcal septicaemia associated with splenic rupture; Buist MD et al.; OBJECTIVE: To present the first report of ruptured spleen associated with meningococcal septicaemia . CLINICAL FEATURES: A 13-year-old girl presented with an acute abdomen and clinical signs of meningococcal septicaemia . Features of her illness placed her in a high mortality group . INTERVENTION AND OUTCOME: She required cardiovascular and respiratory support in the Intensive Care Unit . Failure to initially identify the organism led to percutaneous fine-needle aspiration of fluid in the lesser sac . A laparotomy revealed free intraperitoneal blood and a ruptured spleen . During the course of her illness she was given penicillin and methylprednisolone, and required haemodialysis . She made a complete recovery . CONCLUSION: Ruptured spleen does occur with severe meningococcaemia, and may complicate management.

Lancet, 1991 Nov 2, 338(8775), 1093 - 6
Effect of outer membrane vesicle vaccine against group B meningococcal disease in Norway; Bjune G et al.; For more than 15 years, Norway has had the highest incidence of meningococcal disease in northern Europe, with 80% of cases being due to serogroup B meningococci . The case-fatality has remained high, at about 10% . In this study, an outer membrane vaccine, which had previously been shown to induce an increase in bactericidal antibodies to the parent strain, was assessed in a large-scale, randomised, double-blind trial . From October, 1988, 171,800 students in secondary schools volunteered to take part in a double-blind, placebo-controlled, efficacy trial with school as the randomisation unit . Hospitals and clinics that routinely receive patients with infectious disease were asked to report urgently all cases of suspected meningitis and/or septicaemia in 13-21-year-old students in Norway . These cases were registered and further investigated according to a detailed protocol . 89 out of the 221 cases investigated by June 3, 1991, were shown to be severe systemic disease due to group B meningococci . 36 cases in 35 schools took part in the trial (11 schools with vaccinated students and 24 with students given placebo) . The calculated rate of protection was thus 57.2% (p = 0.012, one-sided test) . The findings suggest that, although the vaccine conferred protection against group B meningococcal disease, the effect was insufficient to justify a public vaccination programme.

APMIS, 1991 Nov, 99(11), 965 - 71
Granulocyte functions and Neisseria meningitidis: influence of properdin-deficient serum; Soderstrom C et al.; Granulocyte-mediated reactions such as opsonization, chemotaxis, and release of granulocyte myeloperoxidase and lactoferrin were studied in properdin-deficient and normal human serum incubated with serogroup A and W-135 meningococci . There were no differences between the sera when serogroup A meningococci were studied . Opsonic and chemotactic activity were impaired against serogroup W-135 meningococci in properdin-deficient serum . Restitution with properdin restored both activities . We found similar release of myeloperoxidase and lactoferrin from granulocytes challenged with serogroup A or W-135 meningococci in either sera . These findings are in accordance with the clinical observations of meningococcal infections caused by serogroup W-135 in properdin-deficient patients as well as the absence of infections caused by serogroup A meningococci.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Nov, (11), 14 - 7
{The effect of the nature of the strain on the character of the production of iron-dependent proteins by meningococci}; Gorbacheva BO et al.; The comparative study of three Neisseria meningitidis strains (15, 125, 2394) was carried out by the method of electrophoresis in polyacrylamide gel in the presence of sodium dodecyl sulfate and by the method of immunoblotting . The intensive expression of 8 iron-regulated proteins (IRP) was shown to occur in iron-deficient culture medium . The major IRP with a molecular weight of 35 kD was expressed by all above-mentioned N . meningitidis strains under the conditions of iron deficiency and cross-reacted with 10 mouse and rabbit antisera to N . meningitidis of different groups, i.e . it was common to all Neisseria species . The antigenic activity of various IRP essentially differed with respect to antisera of animals and sera of patients with meningococcal infection.

J Clin Microbiol, 1991 Nov, 29(11), 2489 - 93
Emergence of a virulent clone of Neisseria meningitidis serotype 2a that is associated with meningococcal group C disease in Canada; Ashton FE et al.; Multilocus enzyme electrophoresis was used to characterize 378 isolates of Neisseria meningitidis serogroup C recovered during a period of an increase in group C meningococcal disease in Canada . Thirty-four enzyme electrophoretic types were found among the isolates, which were predominantly (96.0%) serotype 2a . One clone (ET 15), characterized by a rarely occurring allele for the enzyme fumarase, was responsible for a focal outbreak in Ontario followed by the spread of group C disease across the province . This clone, which occurred infrequently among strains isolated in 1986, accounted for over 65% of group C strains associated with meningococcal disease in Canada in 1990.

Arch Dis Child, 1991 Nov, 66(11), 1296 - 9
Deficiency of prostacyclin production in meningococcal shock; Heyderman RS et al.; A deficiency of prostacyclin (PGI2) production by the vascular endothelium might underline the severe vasoconstriction and intravascular thrombosis that characterise meningococcal shock . The effect on PGI2 synthesis by human umbilical vein endothelial cells (HUVEC) in culture was examined in sera from children with meningococcal shock, healthy adults, and children with other febrile illnesses . In comparison with adult controls, PGI2 synthesis was reduced when HUVEC were incubated with the sera from 10 of 13 patients with meningococcal shock . A similar defect was observed with only four of 20 sera from children with other febrile illnesses . The effect of sera from patients with meningococcal shock on HUVEC was reversible with normal serum, and seems to be due to the absence of a factor necessary for PGI2 production rather than an inhibitor . These findings suggest that a deficiency of PGI2 may have a role in the pathogenesis of meningococcal shock and that exogenous PGI2 may be of therapeutic benefit.

Mol Immunol, 1991 Nov, 28(11), 1193 - 200
The influence of the adjuvant Quil A on the epitope specificity of meningococcal lipopolysaccharide anti-carbohydrate antibodies; Verheul AF et al.; Rabbits were immunized with immunotype L3,7,9 phosphoethanolamine (PEA) group containing oligosaccharide-tetanus toxoid conjugates both with and without the addition of the adjuvant Quil A . The epitope specificity of the antibodies present in these antisera was analysed in an immunotype L2 and L3,7,9 specific inhibition ELISA using the homologous and heterologous lipopolysaccharide, oligosaccharide and partial dephosphorylated oligosaccharide as inhibitors . Two groups of antisera could be identified . In one group of antisera, at least two antibody populations are present, namely directed against the PEA group containing determinants on immunotype L3,7,9 lipopolysaccharide and against immunotype L2 specific epitopes in which no PEA group is present . In the second group of antisera, one but probably more antibody populations are detected with a similar specificity towards the conserved epitopes of both immunotypes . In general, immunization with the conjugates only resulted in the induction of antibodies against the PEA group containing epitopes on the L3,7,9 lipopolysaccharide (80%) . Antibodies directed against the conserved epitopes of both immunotypes are mainly evoked with the conjugates in combination with the adjuvant Quil A (80%) . Although these results suggest that the epitope specificity of the antibodies induced depends on the use of Quil A, the influence of genetic factors cannot be excluded . At the moment it is not known whether the differences in epitope specificities are reflected in biological function of these antibodies . However, the induction of antibodies with clearly different epitope specificities after immunization of different rabbits with the same antigen stresses the importance of this kind of analysis when developing a vaccine based on oligosaccharide-protein conjugates.

Lijec Vjesn, 1991 Nov-Dec, 113(11-12), 384 - 6
{Duration of the Neisseria meningitidis serogroup B serotype 2 carrier state}; Bencic Z et al.; Of 168 examined secondary school children from Zagreb, Neisseria meningitidis, serogroup B, serotype 2 was isolated from the pharynx smear taken from 14 healthy carriers, aged 15-18 . Carriership was observed during the period of 19 months . During that period the pharynx smear was taken four times so that in total there were five samples from each examinee, with the purpose of finding Neisseria . Neisseria meningitidis serogroup B, serotype 2 was isolated and identified by using the standard microbiological methods . Serogroup and serotype were identified by the slide agglutination method, and were used group and type specific antisera . Of 14 identified carriers two persons had continuous duration of carriership of N . meningitidis, serogroup B, serotype 2 during the period of nineteen months . In 6 persons over the period of 9 months, in all five samples of pharynx smear the same meningococcus was identified . This epidemiological study has determined the longest duration of carriership of Neisseria meningitidis serogroup B, serotype 2 described so far in the literature . The role of carriership in the occurrence of the meningococcal disease has not been fully explained.

Infect Immun, 1991 Nov, 59(11), 4097 - 102
Insertion of Tn916 in Neisseria meningitidis resulting in loss of group B capsular polysaccharide; Stephens DS et al.; We recently found that the 16.4-kb conjugative transposon Tn916 could be introduced into Neisseria meningitidis by transformation and that it appeared to transpose to many different sites in the chromosome of recipient meningococci . In order to identify transposon-induced alterations of specific meningococcal virulence determinants, a library of meningococcal Tetr transformants containing Tn916 was made and screened for those altered in the production of group B capsular polysaccharide . A capsule-defective mutant, M7, was identified by using monoclonal and polyclonal antisera to group B polysaccharide in immunoblot and agar antiserum procedures . Growth of M7 was similar to that of the parent strain . M7 produced no group B capsular polysaccharide by rocket immunoelectrophoresis, and the mutation was stable during laboratory passage . The capsule-defective phenotype was linked to Tetr, as demonstrated by immunoblot and Southern blot analysis of progeny Tetr transformants (transformants of the parent strain obtained with DNA from M7) . A capsule-deficient mutant, O8, was identified by using a similar approach . Analysis of the Tn916 insertions in M7 and O8 indicated that a significant portion of the transposon on either side of the tetM determinant had been lost . The ability of Tn916 to generate defined, stable mutations in meningococcal virulence determinants is demonstrated by our study.

Ugeskr Laeger . 1991 Oct 14;153(42):2955.
{Necrotizing fasciitis . A rapid fatal course of Streptococcus pyogenes, Lancefield group A serotype M1 (killer streptococci), infection}; Pedersen HS et al.; The case history of necrotizing fasciitis in a previously healthy man aged 37 years is presented . The disease ran a rapidly fatal course . The only finding on bacterial culture was Streptococcus pyogenes, Lancefield group A, serotype M1, ("killer streptococci") . The therapeutic possibilities are briefly outlined and the importance of rapid surgical intervention is emphasized . It is concluded that this patient was actually beyond therapeutic aid less than 12 hours after admission . Necrotizing fasciitis caused by Streptococcus pyogenes, Lancefield group A, serotype M1, is comparable with meningococcal disease . It appears probable that the disease had developed in this patient as a sequel of streptococcal arthritis.

Clin Chem, 1991 Oct, 37(10 Pt 1), 1691 - 5
Radioimmunoassay of interleukin-6 in plasma; Teppo AM et al.; We present a double-antibody radioimmunoassay for determining human interleukin-6 (IL-6) in biological fluids . The detection limit of the assay is 20 ng/L (B0 - 2 SD) . Bound radioactivity in the range of 30% to 90% of the B0 counts corresponds to IL-6 concentrations of 100 to 14,000 ng/L . Analytical recovery of IL-6 added to EDTA-treated plasma averaged 25% more than that added to serum . The plasma concentration of IL-6 was therefore approximately 85 ng/L more than the concentration in simultaneously drawn serum . The mean serum concentration of IL-6 in 45 healthy subjects was 83 ng/L (range 20-290 ng/L), in 20 patients with multiple myeloma 303 ng/L, in 20 patients with rheumatoid arthritis 234 ng/L, and in 13 patients with systemic lupus erythematosus 183 ng/L . Markedly increased (greater than 3000 ng/L) concentrations of IL-6 were found in sera of patients with meningococcus meningitis and infectious peritonitis.

Infect Immun, 1991 Oct, 59(10), 3566 - 73
Minimal oligosaccharide structures required for induction of immune responses against meningococcal immunotype L1, L2, and L3,7,9 lipopolysaccharides determined by using synthetic oligosaccharide-protein conjugates; Verheul AF et al.; The 12 types of meningococcal lipopolysaccharide (LPS) (immunotypes) contain immunotype-specific and cross-reactive epitopes situated on the oligosaccharide part of the LPS molecules . To identify useful cross-reactive epitopes and to determine minimal oligosaccharide structures required for the induction of an immune response against the most prevalent immunotypes, L1, L2, and L3,7,9, synthetic as well as native LPS-derived oligosaccharides were conjugated with tetanus toxoid . L3,7,9 phosphoethanolamine (PEA) group-containing oligosaccharide-tetanus toxoid conjugates evoked high immunoglobulin G (IgG) antibody levels in rabbits which were detected by an L2-, L3,7,9-, and, depending on the antiserum, L1-specific enzyme-linked immunosorbent assay (ELISA) . Inhibition studies revealed that an identical antibody population was detected by L1 and L3,7,9 ELISA, indicating a similar tertiary structure of the inner core oligosaccharide of these two immunotypes . These antibodies recognize PEA group-containing epitopes present on the L1 and L3,7,9 LPS . An L2 PEA group-containing oligosaccharide-tetanus toxoid conjugate elicited L2- and L3,7,9-specific IgG antibodies, but in contrast with the L3,7,9 conjugates, no L1-specific IgG antibodies were evoked . These results indicate that L1 and L2 LPS do not contain cross-reactive epitopes, whereas both L2 and L3,7,9 LPS and L1 and L3,7,9 LPS possess common determinants . Three linear oligosaccharides and one branched oligosaccharide, representing partial structures of the inner core oligosacchardes of meningococcal LPS, were synthesized . Only the branched synthetic oligosaccharide-containing conjugate was able to induce and L1- and L3,7,9-specific immune response, whereas the linear oligosaccharide-protein conjugates evoked L2-specific immune responses . The branched oligosaccharide (beta-D-Glcp(1----4)-{L-alpha-D-Hepp(1----3)}-L-alpha-D-Hepp ) is therefore considered a minimal structure required for the induction of an immune response against L1 and L3,7,9 LPS and part of a cross-reactive epitope between these two immunotypes . For L2-specific immune responses, oligosaccharide structures terminating in beta-D-Glcp(1----4), alpha-D-GlcNAcp(1----2), or L-alpha-D-Hepp(1----5) are needed . The results suggest that it is possible to prepare an oligosaccharide structure with the ability to evoke an immune response against L1, L2, and L3,7,9 LPS . A feasible structure for such a "hybrid" oligosaccharide is discussed.

Microb Pathog, 1991 Oct, 11(4), 249 - 57
Cloning and expression in Escherichia coli of opc, the gene for an unusual class 5 outer membrane protein from Neisseria meningitidis (meningococci/surface antigen); Olyhoek AJ et al.; A genomic library was constructed in a lambda gt11 vector using chromosomal DNA from a meningococcal serogroup A strain and plaques expressing the class 5C protein were recognized by screening with specific monoclonal antibodies . The opc insert was subcloned into a multicopy plasmid which induced expression of that protein in Escherichia coli as a surface-exposed major outer membrane protein . The nucleotide sequence of opc is typical of an outer membrane protein with a promoter and terminator region, a leader peptide which is cleaved during expression and a complete open reading frame . Unlike other meningococcal class 5 proteins or gonococcal P.II proteins, the sequence did not contain any pentanucleotide repeats and the sequence showed little homology to these other functionally related proteins . However, the predicted amino acid sequence of the mature protein for opc showed 27% similarity to that for a second opa gene cloned from the same meningococcal strain . This is the first report of cloning and expression of a functional meningococcal gene encoding a class 5 outer membrane protein in E . coli.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Oct, (10), 55 - 8
{The effect of vaccination on local immunity indices; the determination of antimeningococcal antibodies in saliva}; Martynov IuV et al.; Local immunity characteristics were studied in 130 young males; of these, 80 had been immunized with group A meningococcal vaccine . In nonstimulated saliva, collected prior to vaccination, then on days 7, 14 and 30 after vaccination, the levels of IgA antibodies to group A meningococcal group-specific polysaccharide (PS-A) were determined in the enzyme immunoassay, and secretory IgA and IgA, IgG, IgM were determined by Mancini's method . The study revealed that after the parenteral administration of group A meningococcal vaccine an increase in the concentrations of SIgA and IgA antibodies to PS-A occurred . The manifestation of changes in local immunity characteristics in response to meningococcal vaccine depended on the initial level of IgA antibodies to PS-A.

Microbiologica, 1991 Oct, 14(4), 333 - 6
Meningococcal disease in Italy in 1990; Stroffolini T et al.; The incidence of meningococcal disease in Italy in 1990 was 0.5/100,000 in the general population and 0.7/100,000 in army recruits . The highest proportion of cases (32%) was seen in subjects 1-4 years old . The sex ratio was 1.0 Serogroup B constituted 72% of the isolates; 16% belonged to group A and 12% belonged to group C . The proportion of strains resistant to suphonamides was 56%, while no strain was resistant to minocycline or rifampicin . Two secondary cases, but no comprimary cases occurred among civilians . The predominance of serogroup B and the further decline in military cases constitute the findings of major interest.

Sex Transm Dis, 1991 Oct-Dec, 18(4), 228 - 32
Neisseria meningitidis in specimens from urogenital sites . Is increased awareness necessary?
Hagman M, Forslin L, Moi H, Danielsson D.
Neisseria meningitidis serogroups B type 2 and Y were isolated from urogenital specimens from three heterosexual patients . The first patient was a young man with the clinical signs and microscopic findings of a typical gonococcal urethritis . The second was a middle-aged woman with cervicitis, in whom neither Neisseria gonorrhoeae nor Chlamydia trachomatis were demonstrated by culture . In the third patient, a young woman, N . meningitidis was associated with cervicitis, acute salpingitis, and peritonitis . The patients' clinical symptoms responded quickly to antibiotic treatment . Meningococci of the same serogroup/serotype as the index cases were demonstrated in two of the sexual consorts in pharyngeal specimens but not in genitourinary specimens . Orogenital sexual practice seemed to be the most likely route of transmission . During the period of this study (August 1989-March 1990), the three meningococcal strains observed at the authors' laboratory represented 20% of the total number of urogenital isolates of pathogenic Neisseria . A greater awareness of this problem from medical, diagnostic, epidemiologic, and legal viewpoints is therefore needed.

FEMS Microbiol Lett, 1991 Oct 1, 67(2), 179 - 85
The class 3 outer membrane protein (PorB) of Neisseria meningitidis: gene sequence and homology to the gonococcal porin PIA; Wolff K et al.; The class 3 protein (PorB) is an important component of the meningococcal outer membrane . The structural gene (porB) encoding the class 3 protein has been cloned using primers suitable for the amplification of the corresponding chromosomal fragment by the polymerase chain reaction (PCR) . The complete nucleotide sequence was determined and predicts a mature protein of 310 amino acids, preceded by a signal peptide of 19 residues . The predicted protein sequence of the class 3 protein exhibits essential structural homology to the gonococcal porin PIA . The class 3 protein encoding gene was expressed in Escherichia coli under the control of an inducible promoter.

J Immunol, 1991 Sep 15, 147(6), 1962 - 7
Human IgA1 blockade of IgG-initiated lysis of Neisseria meningitidis is a function of antigen-binding fragment binding to the polysaccharide capsule; Jarvis GA et al.; We have recently shown that human IgA1 can initiate lysis of group C Neisseria meningitidis via the classical C pathway when bound to specific outer membrane proteins, but that IgA1 can also function as a blocking antibody when bound to the polysaccharide capsule of meningococci . In this report, we further characterized IgA1 blockade by examining the effect of IgA1 on IgG-initiated immune lysis of group C meningococci . We purified IgG and monomeric IgA1 from either convalescent group C meningococcal case sera or tetravalent (A, C, Y, W135) polysaccharide vaccinate sera . In the absence of IgA1, IgG initiated complete lysis (greater than 99%) of strains 118V (C:P3,4:L2,4) 126E (C:P3:L1,8), and 35E (C:P5:L2) . Addition of IgA1 to the bactericidal reaction mixture completely blocked the lytic function of IgG . Removal of the Fc portion of IgA1 with either pepsin or IgA1 protease did not affect blockade . Both the F(ab')2 and Fab derivatives of IgA1 blocked lysis quantitatively as well as intact IgA1 . The Fc fragment produced by IgA1 protease cleavage neither increased nor decreased Fab-mediated blockade . IgA1 and its Fab and F(ab')2 fragments blocked IgG-initiated lysis via either the classical pathway in factor B-depleted and in properdin-deficient serum, the alternative pathway in MgEGTA-chelated serum, or both pathways combined . Absorption of the IgA1 and IgG with alum-bound group C polysaccharide completely removed blocking and lytic activity, respectively, indicating that both the blocking IgA1 and the lytic IgG were specific for the group C capsule . Blocking by IgA1 was a linear function of the polysaccharide Ag-binding capacity (ABC) ratio of blocking IgA1 to lytic IgG . Complete blockade was observed at an ABC ratio of 5.5 . At ABC ratios of 3.3 and 4.4, IgA1 affected significant blockade whether added previous to, concurrent with, or subsequent to sensitization of the organisms with IgG . With the use of a C polysaccharide ELISA, we found that the binding of IgA1 to the group C capsule in the presence of IgG exhibited positive cooperativity and therefore that blockade was independent of the ability of IgA1 to directly compete with IgG for binding to epitopes within the group C capsule . We conclude that IgA1, when bound to the group C polysaccharide capsule, can block IgG-initiated lysis of group C meningococci through either the classical or the alternative pathway before or after the organism is exposed to IgG, and that blockade is an Fc-independent event.

J Immunol, 1991 Sep 15, 147(6), 2012 - 8
T cell recognition of Neisseria meningitidis class 1 outer membrane proteins . Identification of T cell epitopes with selected synthetic peptides and determination of HLA restriction elements; Wiertz EJ et al.; No vaccine is yet available against serogroup B meningococci, which are a common cause of bacterial meningitis . Some outer membrane proteins (OMP), LPS, and capsular polysaccharides have been identified as protective Ag . The amino acid sequence of the protective B cell epitopes present within the class 1 OMP has been described recently . Synthetic peptides containing OMP B cell epitopes as well as capsular polysaccharides or LPS protective B cell epitopes have to be presented to the immune system in association with T cell epitopes to achieve an optimal Ir . The use of homologous, i.e., meningococcal, T cell epitopes has many advantages . We therefore investigated recognition sites for human T cells within the meningococcal class 1 OMP . We have synthesized 16 class 1 OMP-derived peptides encompassing predicted T cell epitopes . Peptides corresponding to both surface loops and trans-membrane regions (some of which occur as amphipathic beta-sheets) of the class 1 OMP were found to be recognized by T cells . In addition, 10 of 11 peptides containing predicted amphipathic alpha-helices and four of five peptides containing T cell epitope motifs according to Rothbard and Taylor (Rothbard, J . B., and W . R . Taylor . 1988 . EMBO J 7:93) were recognized by lymphocytes from one or more volunteers . Some of the T and B cell epitopes were shown to map to identical regions of the protein . At least six of the peptides that were found to contain T cell epitopes show homology to constant regions of the meningococcal class 3 OMP and the gonococcal porins PIA and PIB . Peptide-specific T cell lines and T cell clones were established to investigate peptide recognition in more detail . The use of a panel of HLA-typed APC revealed clear HLA-DR restriction patterns . It seems possible now to develop a (semi-) synthetic meningococcal vaccine with a limited number of constant T cell epitopes that cover all HLA-DR locus products.

Hosp Pract (Off Ed), 1991 Sep, 26 Suppl 5, 14 - 9; discussion 54-5
Ceftriaxone in treatment of serious infections . Meningitis; Scheld WM; In many pediatric infectious disease programs, ceftriaxone or cefotaxime is now the preferred drug for bacterial meningitis caused by H . influenzae, meningococci, and pneumococci . Ceftriaxone reaches a high bactericidal titer in the cerebrospinal fluid and persists at the site of infection longer than any other beta-lactam antibiotic . Short-course, once-daily therapy with ceftriaxone requires more study; currently, many pediatricians administer the agent twice daily for suspected or proven meningitis . Given the association of sequelae with prolongation of positive CSF cultures, ceftriaxone's rapid bactericidal activity is an advantage, which may require an adjunctive agent to block the inflammatory response due to antibiotic-induced release of endotoxin and other cell wall components . As empiric therapy, ceftriaxone is effective in infants and children three months to 18 years old . It is not yet recommended in neonates, because of concerns about bilirubin displacement . Thus, infants up to three months of age should receive ampicillin plus cefotaxime . In adults, ceftriaxone is effective therapy for presumed bacterial meningitis but must be combined with ampicillin initially, since L . monocytogenes meningitis cannot be excluded in most cases until CSF culture results are available.

J Infect Dis, 1991 Sep, 164(3), 542 - 9
Effect of polymyxin B on experimental shock from meningococcal and Escherichia coli endotoxins; Baldwin G et al.; Meningococcemia is the most frequent cause of septic shock in healthy children . To determine whether polymyxin B (PMB) might improve mortality from meningococcal shock, its protective activity was evaluated in rabbits challenged with an LD90 of meningococcal lipooligosaccharide (LOS) and compared with an LD80 of Escherichia coli O111:B4 lipopolysaccharide (LPS) . PMB (5 mg/kg) administered intravenously 30 min before meningococcal LOS challenge had no significant effect on heart rate, mean arterial pressure, serum bicarbonate, serum tumor necrosis factor (TNF) levels, or survival relative to controls . However, PMB premixed with LOS in vitro increased serum bicarbonate levels (P less than .05) and improved 24-h survival (P less than .05) . In contrast, PMB given before E . coli LPS challenge increased serum bicarbonate levels, decreased TNF levels, and improved 24-h survival (all, P less than .05) . In vitro studies confirmed that PMB at 10 micrograms/ml neutralized E . coli LPS but not meningococcal LOS activity . Thus, pretreatment with PMB apparently protects rabbits against shock induced by E . coli LPS but not by meningococcal LOS.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Sep, (9), 35 - 7
{The determination of antimeningococcal antibodies in the saliva of healthy people}; Martynov IuV et al.; The determination of antibodies to the group-specific polysaccharide of group A meningococci (PS-A) in the saliva of 162 healthy persons at different seasons of the year revealed that antimeningococcal antibodies could be detected in all examines . The range of concentrations of antibodies to PS-A varied between 0.1 and 33.0 U/ml . The comparison of antibody content with the levels of morbidity in meningococcal infection and carriership made it possible to determine two threshold levels of antibody concentration: 9.0 U/ml and 18.0 U/ml.

J Infect, 1991 Sep, 23(2), 155 - 9
Meningococcal infection: evidence for school transmission; Wall R et al.; Intimate contacts of a patient with meningococcal disease are at greater risk of disease than the general population and are offered chemoprophylaxis in order to prevent secondary cases . School contact is not considered a risk factor unless a further case develops . Bacteriological sampling of contacts to identify potential sources of infection is not considered warranted . We have questioned these approaches and investigated the contacts of a 9-year-old child with meningitis caused by sulphonamide-sensitive Neisseria meningitidis group C . Household carriers were not identified but 7/34 classmates were carrying the index strain suggesting that transmission was occurring within this population . The current recommendations for prophylaxis are based on information gathered in socioepidemiological settings, and involving strains which differ from those now prevalent . Such extrapolations may not be justified and further microbiological studies seem warranted to re-examine meningococcal transmission and prophylaxis usage in school children.

Infect Immun, 1991 Sep, 59(9), 3169 - 75
Evidence for functionally distinct pili expressed by Neisseria meningitidis; Pinner RW et al.; In order to investigate possible functional consequences of phase and antigenic variation of meningococci, the attachment of 15 strains of Neisseria meningitidis to human erythrocytes was studied by a nitrocellulose hemadsorption assay . This assay allows the study of individual meningococcal colonies with respect to erythrocyte attachment . Of the 15 strains studied, 7 demonstrated binding of human erythrocytes (HA+) . Among these seven strains, the percentage of colonies that were HA+ ranged from 0.2 to 97% . Meningococcal colonies that did not produce pilin (the major structural subunit of pili) did not demonstrate erythrocyte binding (HA-) . The HA+ colony phenotype was correlated with assembly of pilin into pili and expression of pili on the meningococcal surface . However, only some piliated colonies bound human erythrocytes . This could not be explained by differences between piliated HA+ and HA- colonies in the amount of pilin produced or by differences in number of pili expressed per diplococcus . Pili of five of the meningococcal strains with HA+ colonies were antigenically related to gonococcal pili (class I meningococcal pili), but HA+ colonies were also seen in two meningococcal strains expressing class II meningococcal pili . Changes from HA+ to HA- and from HA- to HA+, in the presence of continuing pilin production and pilus assembly, occurred at frequencies of up to 10(-2)/CFU per generation . Such frequencies resemble those of phase and antigenic variation described previously for Neisseria species pilin . These studies indicate that phase variation influences the ability of meningococci to attach to human cells and suggest that meningococci may express functionally different pili.

Infect Immun, 1991 Sep, 59(9), 2963 - 71
Topology of outer membrane porins in pathogenic Neisseria spp; van der Ley P et al.; In Escherichia coli, membrane-spanning amphipathic beta-sheet structures are characteristic of many outer membrane proteins . By applying the principles that have been recognized for them to the four classes of neisserial porins, we have constructed a model for the topology of the porins within the outer membrane . This model predicts eight surface-exposed loops, both in the meningococcal class 1 and 2 proteins and in the gonococcal PIA and PIB proteins . The transmembrane sequences are highly conserved among these porins and are able to form an amphipathic beta-sheet structure . The surface-exposed hydrophilic loops show extensive variation in both length and sequence . Experimental evidence in support of this model has been obtained by using antisera against synthetic peptides which correspond to surface-exposed loops in class 1 and 2 proteins . Thus, binding to the cell surface was observed with antibodies against loops 1, 4, and 5 of class 1 and loops 1 and 5 of class 2 . In class 1, these loops are the longest ones and show the highest sequence diversity among strains of different subtypes . Mapping of epitopes recognized by monoclonal antibodies with bactericidal activity has also provided strong support for the model . The epitopes are located in loops 1 and 4 of class 1 protein, loop 5 of PIB, and loop 6 of PIA . A nonbactericidal antibody that binds only weakly to whole cells was shown to recognize loop 3 of PIB . These results suggest that the longest loops are immunodominant, provide the binding sites for bactericidal antibodies, and display the greatest variation among different strains.

Lancet, 1991 Aug 31, 338(8766), 554 - 7
Influenza A and meningococcal disease; Cartwright KA et al.; There are several anecdotal accounts of the association between outbreaks of influenza and meningococcal disease . The exceptional increase in the number of cases of meningococcal infection 2 weeks after an influenza A outbreak in England and Wales during November and December, 1989, provided an opportunity to investigate the relation between the two events . Patients with meningococcal disease in December, 1989, were more likely than age-matched controls to show serological evidence of recent influenza A infection (odds ratio 3.9, 95% Cl 1.2-13.9) . The most likely explanation for the association is immune suppression induced by influenza A, though a lowering of mucosal resistance to meningococcal invasion may also be a factor . Public health authorities should be aware of the association and should be prepared to alert medical practitioners and the public to the increased risk of meningococcal disease when influenza A outbreaks occur.

Proc Natl Acad Sci U S A, 1991 Aug 15, 88(16), 7175 - 9
Antibodies to poly{(2----8)-alpha-N-acetylneuraminic acid} and poly{(2----9)-alpha-N-acetylneuraminic acid} are elicited by immunization of mice with Escherichia coli K92 conjugates: potential vaccines for groups B and C meningococci and E . coli K1; Devi SJ et al.; Meningitis and other systemic infections caused by group B Neisseria meningitidis and Escherichia coli K1 remain important problems . The capsular polysaccharides (CPs) of these pathogens (poly{(2----8)-alpha-N-acetylneuraminic acid} or poly(alpha 2-8NeuNAc} are identical and are virulence factors and protective antigens for both . CP vaccines for these pathogens are not available because poly(alpha 2-8NeuNAc) alone, as a complex or a conjugate, is poorly immunogenic . Because oligomers of poly(alpha 2-8NeuNAc) in fetal brain and other tissues bind antibodies in vitro, it has been suggested that antibodies to this CP might be pathologic . We synthesized conjugates of this CP with tetanus toxoid under conditions that avoid lactone formation . Using this scheme, we also synthesized conjugates of group C meningococcal CP (poly{(2----9)-alpha-N-acetylneuraminic acid} or poly(alpha 2-9NeuNAc} and of E . coli K92 CP {poly(alpha 2-8, alpha 2-9NeuNAc)} . When injected s.c . in saline into mice, conjugates of poly(alpha 2-8NeuNAc) or poly(alpha 2-9NeuNAc) elicited homologous antibodies . E . coli K92 conjugates elicited both poly(alpha 2-8NeuNAc) and poly(alpha 2-9NeuNAc) antibodies . Both components of the conjugates expressed T-dependent immunologic properties under conditions and dosages acceptable for clinical evaluation . Poly(alpha 2-8NeuNAc) antibodies elicited by the homologous or the K92 conjugates had lower binding activities at 37 degrees C than at 22 degrees C . "Natural" poly(alpha 2-8NeuNAc) antibodies were present in almost all matched pairs of human maternal and cord sera; most cord levels were higher than in corresponding maternal sera . These findings suggest that increased levels of poly(alpha 2-8NeuNAc) IgG antibodies elicited by our conjugates will confer protective immunity to group B meningococci and E . coli K1 and will not be pathologic.

Can J Microbiol, 1991 Aug, 37(8), 613 - 7
Serotypes and subtypes of Neisseria meningitidis serogroup B strains associated with meningococcal disease in Canada, 1977-1989; Ashton FE et al.; Typing of Neisseria meningitidis serogroup B disease isolates was carried out using a panel of serotype-and subtype-specific monoclonal antibodies (MAbs) in enzyme-linked immunosorbent assays (ELISA) . Three hundred and sixty-two strains isolated from 1977 to 1986 were typed using five serotyping and seven subtyping reagents and outer membrane vesicles as antigens . Serotype 2b accounted for 30% of the disease isolates . The most common subtype was P1.2, which occurred on 18.5% of all strains or 48.6% of the serotype 2b strains . Of the 362 strains typed, 135 (37.3%) were serotyped and 122 (33.7%) were subtyped . Overall, 185 (51.1%) of the strains could be assigned a serotype and (or) subtype . Strains (221) isolated during the years 1987-1989 were typed using a panel of 6 serotyping and 12 subtyping reagents by whole-cell ELISA . Strains of serotypes 4 (21.7%) and 15 (20.8%) were the most common and carried a wide variety of subtypes . The most common subtypes were P1.2 (11.8%) and P1.16 (9.5%) . Of the 221 strains analyzed, 132 (59.7%) were assigned a serotype and 123 (55.7%) a subtype and with all 18 MAbs, 192 (86.9%) of the strains were serotyped and (or) subtyped . Two different MAbs to the four epitopes 2a, 15, P1.2, and P1.16 gave discordant reactions of 0.3, 6.6, 2.6, and 2.2%, respectively, when used to analyze over 300 strains of N . meningitidis.

J Immunol, 1991 Aug 1, 147(3), 915 - 20
Amino acid sequence of the FV region of a human monoclonal IgM (NOV) with specificity for the capsular polysaccharide of the group B meningococcus and of Escherichia coli K1, which cross-reacts with polynucleotides and with denatured DNA; Gawinowicz MA et al.; The complete amino acid sequences of the VH and VL regions of a biologically significant Ig, IgMNOV, were determined . IgMNOV is reactive with the capsular polysaccharide of the group B meningococcus and of Escherichia coli K1 . As reported earlier, it cross-reacts completely with polynucleotides poly(A) and poly(I) and to a lesser extent with denatured DNA and protects newborn rats against infection with E . coli K1, and is equal in potency to the standard horse anti-group B meningococcal serum . The reduced and alkylated chains were sequenced directly, identifying the L chain as lambda-subgroup II and the mu-H chain as subgroup III . The complete sequence of the VL region was determined by sequencing peptides generated by cleavage with Staphylococcus aureus protease, chymotrypsin, and trypsin . The H chain was cleaved with cyanogen bromide followed by enzymatic cleavages to obtain a large part of the VH region sequence . The structure was completed by sequencing tryptic peptides of the Fab fragment and by mass-spectrometric analysis.

APMIS, 1991 Aug, 99(8), 769 - 72
Immunization against serogroup B meningococci . Opsonin response in vaccinees as measured by chemiluminescence; Lehmann AK et al.; One hundred and thirteen healthy volunteers were immunized twice (six weeks apart) with four different doses (12.5, 25, 50 and 100 micrograms, measured as protein content) of an outer membrane vesicle vaccine from a serogroup B meningococcal strain (44/76, B:15:P1.16) complexed to serogroup C meningococcal polysaccharide and/or Al(OH)3 i.e . 12 different vaccines . Serum opsonic activity against the serogroup B strain was measured using a chemiluminescence method . A significant rise in serum opsonic activity was demonstrated in 84 volunteers (74%) six weeks after the first injection and in 97 (86%) six weeks after the second . All vaccinees with low preimmunization values (less than 25 mVs) experienced a significant increase in opsonic activity . A dose-related response was most evident for the vaccines containing adjuvant, and these vaccines were associated with a maximum response six weeks after the second injection, while the vaccines without Al(OH)3 induced a peak response six weeks after the first injection . The postimmunization opsonic activity was similar to that found in convalescent sera, indicating that the vaccines may protect against serogroup B meningococcal disease.

J Infect Dis, 1991 Aug, 164(2), 375 - 82
Variation in class 5 protein expression by serogroup A meningococci during a meningitis epidemic; Achtman M et al.; Serogroup A meningococci were isolated from patients and healthy carriers in The Gambia between 1982 and 1988 . The class 5 proteins expressed by these bacteria were identified by electrophoretic migration and by serologic tests . Three protein serologic groupings (seroclasses) called A (protein 5a), B (proteins 5b, 5d, or 5e), and C (protein 5c or 5C) were found among 331 bacterial isolates . The number of class 5 proteins expressed per isolate varied from none to four, with a median of two . The class 5 protein composition differed for certain paired isolates obtained from the nasopharynx, blood, and cerebrospinal fluid of diseased patients and for certain pairs of sequential isolates from the nasopharynx of healthy carriers; the medical relevance of this variation remains unclear, although the 5C protein was preferentially isolated from the nasopharynx and the 5a protein from diseased patients . The data show that a large proportion of healthy carriers in The Gambia were exposed to bacteria expressing each of the three seroclasses and that many people were exposed to bacteria expressing each of the three seroclasses and that many people were exposed to two or all three seroclasses during the epidemic of 1982-1983.

J Infect Dis, 1991 Aug, 164(2), 368 - 74
Meningococcal disease in the United States--1986 . Meningococcal Disease Study Group; Pinner RW et al.; Active surveillance for invasive meningococcal disease was conducted during 1986 and 1987 in six areas of the United States with a total population of approximately 34 million persons . The incidence of meningococcal disease was 1.3:10(5) . The highest incidence of disease among the surveillance areas was in Los Angeles County (1.65:10(5) . Neisseria meningitidis serogroups B and C caused about equal amounts of disease, which reflects a recent increase in the incidence of group C disease . Group C caused more than half of the cases of meningococcal disease in Los Angeles and Tennessee but less than one-third of the cases in Missouri and Oklahoma . Multilocus enzyme electrophoresis demonstrated that a group of closely related isolates of N . meningitidis was prevalent in Los Angeles during the surveillance period and was associated with an increased incidence of meningococcal disease there.

Anal Biochem, 1991 Aug 1, 196(2), 421 - 6
Preparation and application of a fluorescein-labeled peptide for determining the affinity constant of a monoclonal antibody-hapten complex by fluorescence polarization; Jiskoot W et al.; A simple and rapid method for determining the affinity constant of a monoclonal antibody-peptide complex under equilibrium conditions is presented . A peptide corresponding to sequence 178-185 of meningococcal strain MC50 class 1 outer membrane protein, which is recognized by monoclonal antibody MN12 (mouse IgG2a), was synthesized . After fluorescein was coupled to the peptide, the peptide-fluorescein conjugate was used for binding studies with MN12, employing fluorescence polarization of the fluorescein label to probe the bound fraction of the peptide . Scatchard analysis showed that the affinity constant was pH dependent . Storage of MN12 under alkaline conditions resulted in a loss of antigen-binding sites, but did not alter the affinity constant . Sips plots showed a homogeneity index of unity.

Mol Microbiol, 1991 Aug, 5(8), 1831 - 41
The role of pili in the interactions of pathogenic Neisseria with cultured human endothelial cells; Virji M et al.; The influence of the two surface structures of Neisseria meningitidis, capsule and pili, in bacterial interactions with human endothelial cells was investigated . Increased association correlated with the presence of pili on bacteria while capsule type had no apparent effect . Strains expressing both Class I and Class II pili associated with endothelial cells in significantly larger numbers compared with the non-piliated variants of the same strains (greater than 10x) . Variants of Neisseria gonorrhoeae strain P9 expressing antigenically distinct pili also associated with endothelial cells in larger numbers (greater than 30x) compared with the non-piliated variant . Electron microscopic studies confirmed these data and showed that gonococci were internalized more frequently compared with meningococci . One consequence of increased association was an increase in the cytopathic effect of bacteria on the target cells.

Acta Virol, 1991 Aug, 35(4), 313 - 21
The complex of flavivirus envelope polypeptide with meningococcal proteosomes elicits formation of virus-neutralizing antibodies; Slavik I et al.; Polypeptide E of tick-borne encephalitis virus was isolated in sucrose density gradient and mixed with equal weight portion of meningococcal proteosomes in the presence of N-dodecyl-N,N-dimethylglycine . Mutual complexing of viral and bacterial molecules occurred after removal of detergent by dialysis . Complexed particles appeared in the electron microscope as 40-50 microns thick short-rod structures covered on their surface with both, delicate poppy-like grains, or envelope subunit-like clustered molecules . Even when applied without adjuvant, the complex of tick-borne encephalitis virus polypeptide E with meningococcal proteosomes elicited in mice a marked antiviral as well as antibacterial humoral response.

S Afr Med J, 1991 Jul 20, 80(2), 105 - 6
Deficiency of the seventh component of complement . A case report; Cooper RC et al.; Deficiency of the 7th component of the complement cascade was diagnosed in a white male with recurrent meningococcal infections . This deficiency has not previously been reported in South Africa.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Jul, (7), 48 - 51
{The characteristics of the serological diagnosis of meningococcal infection in children in the 1st years of life}; Martynov IuV et al.; The results of clinico-immunological examination of 181 children, aged 1 month to 6 years, with generalized forms of meningococcal infection are presented . In children under observation antimeningococcal antibodies to group-specific meningococci of the main groups A, B and C were determined over the course of the disease by passive hemagglutination (PHA) test and enzyme immunoassay (EIA) . The level and frequency of seroconversion were found to depend on the patient's age and the severity of the clinical course of meningococcal infection . Antibody level was found to increase simultaneously with respect to several meningococcal polysaccharides: A, B in 18.5% and A, B, C in 3.3% of cases . In the clinical interpretation of data obtained in the PHA test and EIA not only the patient's age, the form and duration of meningococcal infection, but also serotherapy should be taken into consideration, as the latter may distort the serological results.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Jul, (7), 29 - 32
{The drug sensitivity of meningococci and the characteristics of its determination}; Deviatkina NP et al.; The results obtained in the study of antibiotic and sulfamide sensitivity of 197 Neisseria meningitidis strains of groups A, B and C, isolated from the spinal fluid and blood of patients with meningococcal infection hospitalized in the 2nd Clinico-Infectious Hospital, Moscow, in 1984-1989 and studied with the use of the disc diffusion method and the method of serial dilutions of antibiotics in solid culture media, are presented . As revealed in this study, N . meningitidis strains retained their high sensitivity to penicillin and ampicillin (MIC50 = 0.016 and 0.032 micrograms/ml respectively) . Sensitivity to tetracycline decreased (MIC50 = 0.5 micrograms/ml) and to rifampicin increased (MIC50 = 0.063 micrograms/ml) . 48.5% of strains were resistant to streptomycin . In recent years the proportion of N . meningitidis, resistant to sulfanilamide preparations, significantly decreased and MIC50 was equal to 2.5 micrograms/ml in comparison with 5-10 micrograms/ml in the preceding period . The results of testing sensitivity to antibiotics by both methods coincided . Still the disc diffusion method can be used in epidemiological surveillance on meningococcal infection, while for more exact differentiation of N . meningitidis strains the use of the method of serial dilutions is necessary.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Jul, (7), 17 - 20
{The antilysozyme activity of meningococci}; Bukharin OV et al.; The antilysozyme activity of 184 meningococcal strains was studied . Such activity was found in all strains within the range 1-25 micrograms/ml, which was due to the heterogeneity of bacterial population . Strains varying in the total level of their lysozyme activity differed in the population structure by this sign . Preparations inhibiting antilysozyme activity could be differentiated according to the character of their action by the method of the population analysis . In the process of phagocytosis the selection of clones with a high level of antilysozyme activity was found to occur . The antilysozyme factor, heat resistant protein with a molecular weight of 10,000-30,000 D, was sensitive to trypsin.

Clin Exp Rheumatol, 1991 Jul-Aug, 9(4), 411 - 2
Isolated septic meningococcal arthritis; Mader R et al.; Among the different types of arthritis associated with meningococcal disease, isolated primary meningococcal arthritis is unusual . A case of isolated group C meningococcal septic arthritis in an HIV negative homosexual male is described and its possible implication discussed.

Eur J Epidemiol, 1991 Jul, 7(4), 431 - 3
Meningococcal meningitis in Italy: 1887-1986; Ballada D et al.; In Italy three epidemic peaks of meningococcal meningitis have occurred reflecting pandemic recrudescence of the disease . The seasonal distribution of the disease is similar in the epidemic or non-epidemic periods . There is no significant difference in the regional distribution of the disease . The disease is more prevalent among young males . The prevalent serogroup of Neisseria meningitidis is C . There has been a decrease in resistance to sulphonamides and an increase to rifampin among the isolated strains.

J Clin Microbiol, 1991 Jul, 29(7), 1486 - 92
Characterization of serogroup A and B strains of Neisseria meningitidis with serotype 4 and 21 monoclonal antibodies and by multilocus enzyme electrophoresis; Wedege E et al.; The reactions of serogroup A strains of Neisseria meningitidis with one monoclonal antibody specific for serotype 21 and three different monoclonal antibodies specific for serotype 4 were compared with those of serogroup B strains previously assigned to serotype 4 . Antibody binding was studied by enzyme-linked immunosorbent assay (ELISA), dot blotting, and immunoblotting . Characterization of the isolates by the electrophoretic mobilities of 14 metabolic enzymes showed 50 multilocus enzyme genotypes . All except two genotypes fell into three distinct clusters: I, IIa and IIb . The enzyme genotypes of serogroup B strains were mainly in cluster I, and 88% of the serogroup A strains had genotypes in clusters IIa and IIb . Serogroup B strains generally reacted with all three serotype 4 monoclonal antibodies in ELISA and dot blotting but with only two in immunoblots . Serogroup A strains showed two different reactions in the blotting methods: either binding of the serotype 21 antibody only or binding of this and two of the three serotype 4 monoclonal antibodies . Strains of the first pattern were in clusters I and IIa, whereas all but two strains in cluster IIb were of the second pattern . In ELISA, an additional reaction of two of the serotype 4 monoclonal antibodies with serogroup A isolates was observed . The different binding of these two monoclonal antibodies in ELISA and the blotting methods appeared to result from heat inactivation of the meningococcal cells and use of detergent-containing reagents in ELISA . The results show that the serotype of serogroup A strains is distinct from serotype 4 of serogroup B strains.

J Clin Microbiol, 1991 Jul, 29(7), 1447 - 52
Production of polyclonal and monoclonal antibodies against group A, B, and C capsular polysaccharides of Neisseria meningitidis and preparation of latex reagents; Nato F et al.; Polyclonal and monoclonal antibodies against capsular polysaccharides of Neisseria meningitidis serogroups A, B, and C were produced in order to develop immunological reagents allowing both the detection of soluble antigens during meningococcal meningitis and antigenic serogrouping of N . meningitidis cultures . The performance characteristics of monoclonal and polyclonal antibody latex reagents were compared . For the detection of soluble polysaccharide antigen, polyclonal antibody latex reagent was selected for N . meningitidis A and C . The latex reagent prepared with polyclonal antibodies against N . meningitidis B could not detect capsular polysaccharide even at 1 mg/ml . The monoclonal antibody B latex reagent which detected 100 ng of polysaccharide per ml was therefore chosen . For the serogroup identification of N . meningitidis, the use of a confirmatory test results in an overall specificity of 100% with polyclonal or monoclonal antibody latex reagents.

J Clin Microbiol, 1991 Jul, 29(7), 1356 - 8
Monoclonal antibodies specific for the phase-variant O-acetylated K1 capsule of Escherichia coli; Torensma R et al.; Two monoclonal antibodies, one each of the immunoglobulin M and G2b types, were produced from mouse spleen cells . These monoclonal antibodies only reacted with approximately 50% of the Escherichia coli K1 strains and not against group B meningococci . No reaction was observed after the strains were boiled . E . coli K1 strains that reacted with the monoclonal antibodies could become nonreactive after subculture . Based on these findings, we conclude that the monoclonal antibodies react with the O-acetylated K1 capsule.

An Esp Pediatr, 1991 Jul, 35(1), 21 - 5
{Hemodynamic study in meningococcal septic shock}; Mar Molinero F et al.; We analyzed 8 cases of meningococcal septic shock diagnosed in a three year period . The age varied from 20 months to 10 years (mean: 4.8 years) . Two patients died . Every child was monitored with a Swan-Ganz catheter 5 F or 7F, placed on by puncture of internal jugular or subclavicular veins . Of this hemodynamic study, we can conclude that in septic shock, there is a myocardial depression, that persist for several days, and improves with dopamine and dobutamine . In addition to this, in sepsis exists a pulmonary hypertension that makes worse the prognosis.

Lancet, 1991 Jun 29, 337(8757), 1568 - 9
Rapid diagnosis of meningococcal meningitis by polymerase chain reaction; Kristiansen BE et al.; Rapid diagnosis of meningococcal disease followed by early treatment is essential . However, culture of blood or cerebrospinal fluid (CSF) may be unsuccessful because antibiotic treatment is often started before adequate specimens are collected, and because bacteria may die during transportation to the laboratory . We have used the polymerase chain reaction (PCR) to detect meningococcal DNA in a culture-negative CSF of a 15-year-old girl with meningococcal disease . Two oligonucleotides flanking the dihydropteroate synthase gene (dhps) of Neisseria meningitidis were used as primers . The PCR reaction is a rapid technique for the early detection of meningococcal meningitis, and also when culture is negative.

Harefuah, 1991 Jun 2, 120(11), 641 - 3
{Alternating rifampicin and ceftriaxone for Neisseria meningitidis eradication in contacts}; Shehab S et al.; Following the occurrence of a case of meningococcal disease in a kibbutz, extensive preventive measures were instituted, consisting of alternate courses of rifampicin (10 mg/kg for 2 consecutive days) and ceftriaxone (single IM injection of 125 mg) . Throughout the observation period Neisseria meningitidis was absent from oropharyngeal secretions of all those treated, but was found in those of an untreated control group . The alternate use of rifampicin and ceftriaxone should be considered for the long-term prevention of the occurrence of oropharyngeal carriers of Neisseria meningitidis.

Epidemiol Infect, 1991 Jun, 106(3), 445 - 57
Pharyngeal carriage of Neisseria meningitidis and Neisseria lactamica in households with infants within areas with high and low incidences of meningococcal disease; Olsen SF et al.; In a household survey in the Faroe Islands, an isolated community with hyperendemic occurrence of meningococcal disease due to serogroup B 15, 1604 persons were examined for pharyngeal carriage of Neisseria meningitidis and N . lactamica . Two areas were chosen having experienced high (HIA), and two having experienced low incidences (LIA) of disease . Living in HIA compared with LIA was associated with higher risk of N . meningitidis B 15 carriage and lower risk of N . lactamica carriage, with odds ratios of 2.7 (95% confidence interval (CI) 1.4-5.1, P = 0.003) and 0.41 (95% CI 0.31-0.53, P less than 0.0001), respectively . In HIA the risk of N . meningitidis carriage was much lower in non-carriers than carriers of N . lactamica, with an odds ratio of 0.19 (95% CI 0.08-0.47, P = 0.0003); in LIA this association (odds ratio 0.51, P = 0.05) was much weaker . Children 0-14 years had substantially higher risk of being carriers of N . meningitidis group B 15 if the mothers were so, with an odds ratio of 11 (95% CI 4-29, P less than 0.0001).

NIPH Ann, 1991 Jun, 14(1), 11 - 22
Systemic meningococcal disease: the diagnosis on admission to hospital; Borchsenius F et al.; The clinical and laboratory findings in 176 patients hospitalized with suspected systemic meningococcal disease (MCd) are presented . All except nine patients were prospectively included in the MenOPP study . One hundred and fifteen patients were most likely to have meningococcal disease, of these 71 were confirmed with growth of meningococci in blood and/or cerebrospinal fluid (CSF) . The remaining sixty-one patients served as the control group . Both petechiae, reduced general condition, and reduced consciousness proved valuable in the diagnosis of MCd . Petechiae was the clinical sign best discriminating between MCd and the control group . Ecchymoses were specific for meningococcal disease . Among the laboratory tests C-reactive protein (CRP) and Thrombotest (TT) were the tests which most frequently were found to be abnormal in patients with meningococcal disease . A diagnostic score is computed by the aid of a multiple regression analysis . This score includes the variables skin hemorrhages, body pain, CSF cell count, TT, CRP and white blood cell count . For a patient hospitalized with suspected MCd a score of three or more supports the diagnosis and should indicate the need for rapid antibiotic therapy.

Mol Microbiol, 1991 Jun, 5(6), 1429 - 37
Characterization of the opa (class 5) gene family of Neisseria meningitidis; Aho EL et al.; Class 5 outer membrane proteins of Neisseria meningitidis show both phase- and antigenic variation of expression . The proteins are encoded by a family of opa genes that share a conserved framework interspersed with three variable regions, designated the semivariable (SV) region and hypervariable regions 1 (HV1) and 2 (HV2) . In this study, we determined the number and DNA sequence of all of the opa genes of meningococcal strain FAM18, to assess the structural and antigenic variability in the family of proteins made by one strain . Pulsed field electrophoresis and Southern blotting showed that there are four opa genes in the FAM18 chromosome, and that they are not tightly clustered . DNA sequence analysis of the four cloned genes showed a modest degree of diversity in the SV region and more extensive differences in the HV1 and HV2 regions . There were four versions of HV1 and three versions of HV2 among the four genes . Each of the FAM18 opa loci contained a gene with a unique combination of SV, HV1, and HV2 sequences . We used lambda gt11 cloning and synthetic peptides to demonstrate that HV2 sequences completely encode the epitopes for two monoclonal antibodies specific for different class 5 proteins of FAM18.

Acta Paediatr Jpn, 1991 Jun, 33(3), 352 - 6
An epidemic of meningococcal disease in Karachi (Pakistan): a study of children; Dure-Samin A et al.; A prospective study of 112 cases of epidemic meningococcal infection in the paediatric population is presented . The natural course of the disease, its complications, prognostic factors and therapeutic agents were studied . The cases were graded according to fixed criteria of severity which correlated well with the outcome of the disease . The gram-stain of the CSF was a sensitive and a quick method of diagnosis and crystalline penicillin a cost-effective therapy giving a good response within 48 hours in 90% of the cases.

Dtsch Med Wochenschr, 1991 May 17, 116(20), 772 - 4
{Therapy-refractory fulminant meningococcal sepsis}; Eigentler A et al.; Two cases of the severe form of meningococcal infection are described . A 17-year-old girl and a (unrelated) 2-year-old boy suddenly developed fever and rigor . Several hours later petechiae of the skin were noted: they rapidly spread . On admission the girl was found to have a severe consumptive coagulopathy (prothrombin 24%, partial thromboplastin time 104 sec, fibrinogen 73 mg/dl, platelets 35,000/microliters) . She died two-and-a-half hours after admission of treatment-resistant shock . The boy had at first only a low prothrombin value (39%), but later the other coagulation values also became abnormal . He died 16 hours after admission from the consumptive coagulopathy and profound anaemia (haemoglobin 7.4 g/dl, haematocrit 0.23) . Neither patient had any clinical signs of meningitis . Isolation of Neisseria meningitidis from blood cultures confirmed the diagnosis.

J Infect, 1991 May, 22(3), 273 - 6
Selective C7 complement deficiency causing recurrent meningococcal infection; McBride SJ et al.; We report on two sisters both with complete absence of the 7th component of complement . This congenital immunodeficiency disorder is associated with recurrent bacterial infection, especially that due to Neisseria species . These cases illustrate many of the well-recognised features of this disorder, but in one patient the illness was complicated by infective endocarditis due to N . meningitidis, a feature not previously reported.

J Infect, 1991 May, 22(3), 259 - 61
Association of myocarditis and acute renal failure complicating meningococcal septicaemia; DaCosta DF et al.; We report a case of meningococcal septicaemia complicated by myocarditis, cardiogenic shock and acute renal failure . Following protracted haemodynamic support and haemodialysis, there was complete recovery of cardiac and renal function.

Arch Intern Med, 1991 May, 151(5), 1005 - 9
A cluster of meningococcal disease on a school bus following epidemic influenza; Harrison LH et al.; An outbreak of meningococcal disease among children on a school bus offered the opportunity to study a proposed association between this infection and preceding influenza infection . Five students who rode the bus became ill with invasive group C meningococcus . Transmission was limited to the bus; there was no evidence for school transmission . All five students reported influenza-like symptoms within several weeks before the development of meningococcal disease . School absenteeism, principally due to upper respiratory tract illness, was higher during the 3 weeks before the outbreak of meningococcal disease than during any period in the preceding 3 1/2 years, suggesting an unusually severe outbreak of respiratory illness . A case-control study comparing students with and without influenza symptoms revealed that the outbreak of respiratory disease was due to B/Ann Arbor/1/86 influenza (geometric mean titers, 86 for 80 patients and 33 for 47 controls {P = .0007}) . These data add to the evidence suggesting that influenza respiratory infection predisposes to meningococcal disease.

Ir J Med Sci, 1991 May, 160(5), 134 - 6
A change in meningococcal serogroups in the west of Ireland?
Corbett-Feeney G.
Admission of patients to University College Hospital, Galway over a five month period commencing December 1989 indicates an increase in the incidence of Neisseria Meningitidis Serogroup C . Seven cases of Group CN . Meningitidis have been identified, five of them occurring over a four week period . A review of Meningococcal isolates occurring at this hospital over eleven years since 1979 shows, serogroup B as the predominant serogroup . Thirty-six isolates identified by serogrouping shows the distribution of serogroups as follows: Serogroup B 69.4%, Serogroup C 19.4%, Serogroup A 8.3%, Serogroup Z 2.7% . Serogrouping, and when available, further serotyping of meningococcal isolates is very important in order to follow epidemiological trends in the disease and to monitor the serogroups that cause outbreaks . This information can influence measures that can be taken in the prevention of spread of the disease as for example the use of vaccination as appropriate.

Voen Med Zh, 1991 May, (5), 51 - 2
{The heterogeneity of formed collectives in susceptibility to meningococcal adhesion}; Tatarnikov VM et al.; 4 patients with meningococcal infection and 141 meningococcal carriers were examined . The authors study heterogeneity of human population concerning susceptibility or stability of erythrocytes to adhesive influence of meningococci . In 17.4% of cases erythrocytes were highly susceptible to adhesion of meningococci, in 20.4% were stable to this influence, in 62.2% were moderately susceptible . The highest susceptibility of erythrocytes (out of statistics) was marked at the patients of Kirghiz and Tadjik nationalities . These indexes have the same statistic frequency for the persons with different blood groups (system ABO), independently of their rural or urban place of residence . The high susceptibility of erythrocytes (0.25 GAE or less) to adhesion of meningococci is three times more frequent among the persons with meningococcal infection and carriers of meningococcus . This connection may be regarded as a predisposition of the organism for the infection . Thus, the susceptibility of erythrocytes to adhesion of meningococci gives the possibility to determine the persons who need an urgent immunization at the forming collectives.

Eur J Clin Microbiol Infect Dis, 1991 May, 10(5), 399 - 404
Meningococcal chest infections in a general hospital; Davies BI et al.; In the course of one calendar year (1989-1990), 46 specimens of respiratory secretions (from 44 patients) cultured in the microbiology department of a large district general hospital in The Netherlands were found to yield Neisseria meningitidis . Twenty-eight of the 46 samples yielded pure cultures of meningococci and 18 yielded other recognised respiratory pathogens as well . Only one patient had pneumonia, whereas 19 had acute respiratory infections and 18 acute purulent exacerbations of chronic bronchitis . The remaining patients, who had a variety of symptoms, all had purulent sputum . Only 8 of the 44 patients were under 40 years of age; 21 were aged more than 60 years . Serological grouping and subtyping showed a predominance of group B strains (in 24 of 44 patients) and 13 strains were non-groupable . The importance of recognising or overlooking meningococci in cultures of respiratory secretions is discussed.

An Esp Pediatr, 1991 May, 34(5), 355 - 9
{Studying the levels of endotoxemia in meningococcal sepsis . Its relations to pregnancy and antibiotic treatment}; Loscertales Abril M et al.; The most frequent cause of toxic shock in our area is meningococcal sepsis . It is currently assumed that endotoxin produce by this bacteria, a lipopolysaccharide with toxic properties, is able to trigger shock and DIC by stimulating both arachidonic acid pathways, among other actions . Previous studies in our laboratory demonstrated significant differences (p +/- 0.001) in the amounts of endotoxins released in vitro by strains from patients and healthy carriers and statistically related criteria of severity with mortality in 256 patients in our center over the last 10 years . In the present study we attempted to establish whether plasma levels of endotoxin were correlated with the severity of the disease . We studied 32 patients with meningococcal sepsis, dividing the subjects into two groups: those in whom six or more criteria of severity were present, and those in whom less than six criteria were found . Blood levels of endotoxin were determined upon admission and after the administration of antibiotics (penicillin and chloramphenicol) using the limulus test with a chromogenic substrate (Coatest, Endotoxin, Kabivitrum, Sweden) . Levels of endotoxins were significantly higher in patients with more than six criteria of severity both upon admission (0.6 +/- 0.03) ng/ml) and 4 h . afterward (0.74 +/- 0.006 ng/ml) in comparison to children in whom the clinical picture was less serious (0.27 +/- 0.18 ng/ml and 0.27 +/- 0.18 ng/ml and 0.27 +/- 0.16 ng/ml7 t = 5.8 y t = 5.6 respectively . Endotoxin levels were highest in patients presenting shock, disseminated intravascular coagulation in the hypocoagulability phase and more than 8 criteria.(ABSTRACT TRUNCATED AT 250 WORDS)

An Esp Pediatr, 1991 May, 34(5), 349 - 54
{Meningococcal sepsis in our area . Study of the disease severity factors and therapeutic management over a 10-year period}; Loscertales Abril M et al.; Meningococcal sepsis with cardiovascular manifestations is one of the leading causes of pediatric intensive care admission (14.85%) in our area . We carried out a two phase study over period of 10 years from 1979 to 1988, involving a retrospective analysis of clinical and analytical manifestations in order to determine a prognostic score of the severity of meningococcal infections in our area . A total of 86 cases were studies over a two year period . After establishing the prognostic score, we applied a previously assayed therapeutic protocol, based on the number of criteria of severity, in 170 children selected as having the same criteria . The factors of seriousness considered were: Appearance of the first symptoms less than 12 h . previously, appearance of petechia less than 6 h . previously, hyperthermia, shock at admission, absence of meningitis, fulminating course of purpura and convulsions, leukopenia less than or equal to 5,000 mm3, prothrombin activity less than or equal to 45%, platelets less than or equal to 75,000 mm3, fibrinogen less than or equal to 250 mgrs% and FPD greater than 40 micrograms/ml (p less than or equal to 0.01 (CHI SQUARE} . In the first phase of study, overall mortality was associated with the presence of three criteria, and was highest when more than seven criteria were present . The results indicate that mortality from meningococcal sepsis is linked to fulminating deterioration of hemodynamics and DIC.(ABSTRACT TRUNCATED AT 250 WORDS)

J Bacteriol, 1991 May, 173(9), 2823 - 32
Endogenous sialylation of the lipooligosaccharides of Neisseria meningitidis; Mandrell RE et al.; Monoclonal antibodies (MAb) 3F11 and 06B4 recognize epitopes that are conserved on gonococcal lipooligosaccharides (LOS), present on some meningococcal LOS, and conserved on human erythrocytes . LOS of some group B and C prototype meningococcal LOS strains (LOS serotypes L1 to L8) treated with neuraminidase showed increased expression of the 3F11 and 06B4 MAb-defined epitopes . Neuraminidase-treated LOS separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and silver stained showed a shift in migration from a component with a mass of approximately 4.8 kDa to a component with a mass of between 4.5 and 4.6 kDa . The same strains grown in medium with excess CMP-N-acetylneuraminic acid had LOS that shifted in migration to a slightly higher component (mass, approximately 4.8 kDa) . Chemical analysis of the neuraminidase-digested products from one LOS indicated it contained approximately 1.5% sialic acid . Covalent linkage between sialic acid and the LOS was confirmed by analysis of de-O-acylated and dephosphorylated LOS by liquid secondary ion mass spectrometry . Three studies show that some meningococci contain sialic acid in their LOS, that the sialic acid is cleaved and lost in conventional acetic acid hydrolysis, and that the sialic acid alters the expression of MAb-defined epitopes.

Ugeskr Laeger, 1991 Apr 15, 153(16), 1113 - 6
{Occurrence of complement defects in meningococcal disease: who should be examined?}; Nielsen HE et al.; Congenital complement deficiency states occur very rarely . These deficiencies are associated with a high risk of meningococcal disease (MD) . We suggest that the following groups of individuals with MD are examined for complement deficiencies: 1 . Individuals belonging to families, in which more than one case of MD has occurred with an interval exceeding one month . 2 . Individuals infected with the low-virulent meningococcal serogroups W-135, 29E, X, Y, Z . 3 . Individuals with recurrent MD . Since properdin deficiency probably is the most common deficiency associated with MD it is important that the screening includes the alternative complement pathway.

Sex Transm Dis, 1991 Apr-Jun, 18(2), 129 - 30
"Primary" gonococcal meningitis; Billings FT 3rd et al.; A 39-year-old man had meningitis, which subsequently proved to be due to Neisseria gonorrhoeae . This report describes the second known case of primary gonococcal meningitis . This disease mimics meningococcal meningitis closely, and the diagnosis can only be made by careful bacteriologic study.

Zhonghua Liu Xing Bing Xue Za Zhi, 1991 Apr, 12(2), 69 - 71
{Observation on the epidemiologic efficacy for 9 years on epidemic meningococcal polysaccharide vaccine of group A by district immunization method}; Ma Z; According to previous studies, there might be a peak of epidemic meningitis in Baoding City in 1984 . For preventing the epidemic, we carried out vaccination with meningococcal polysaccharide vaccine by district immunization method during the 1980-1984 and then vaccination only to the children aged 12-24 months every year . The vaccination rate was 80.01% in 1980-1984 and was 97.15% in 1985-1988 . During the 9 years, 833,377 children of vaccination group were observed, 4 of whom developed this disease, with an incidence of 0.48/100,000; and 304,085 children in the control group were observed, 25 of whom contracted this illness, with an incidence of 8.22/100,000 . The protective rate of vaccine was 94.16% and the efficacy index was 1:17.12 . This result showed that peak year of epidemic meningitis predicted in 1984 was prevented by vaccine immunization and the incidence of this disease was continuously kept less than 1/100,000 for 9 years.

Arch Dis Child, 1991 Apr, 66(4), 485 - 7
Features and outcome in meningococcal disease presenting with maculopapular rash; Marzouk O et al.; Sixty nine patients with meningococcal disease some of whom presented with a maculopapular rash were entered in a prospective multicentre study . The clinical and laboratory features of children presenting with maculopapular rashes were compared with those of children presenting with typical haemorrhagic rashes . Of the 69 children 26 (38%) developed maculopapular rashes; nine (13%) had a maculopapular rash only, and the remaining 17 had a mixed maculopapular-purpuric rash . Twelve of the 17 (7%) had less than 12 petechiae . Children with maculopapular rashes had significantly higher platelet counts (median 294 compared with 243 x 10(9)/l), and plasma total haemolytic complement activity (80.5 compared with 65.0 U/ml) and significantly lower Glasgow meningococcal septicaemia prognostic scores (2.5 compared with 5.5) than those with purpuric rashes on admission . There were no significant differences between the groups in mortality, white cell count or absolute neutrophil count on admission, or C reactive protein concentration . Meningococcal disease can present with a maculopapular rash alone but this does not necessarily mean that the disease is less severe.

Sex Transm Dis, 1991 Apr-Jun, 18(2), 72 - 5
Urogenital infection due to meningococcus in men and women; Conde-Glez CJ et al.; The authors report six cases of acute urethritis and three cases of acute cervicitis caused in all instances by Neisseria meningitidis group B . The patients, five heterosexual men, one homosexual man, and three female prostitutes were seen at a venereal clinic in Mexico City . All of them were initially diagnosed as having gonorrhea . Treatment with procaine-penicillin G cured all cases, both clinically and bacteriologically . These experiences reinforce the need to distinguish N . meningitidis from N . gonorrhoeae in the setting of sexually transmitted diseases.

Epidemiol Infect, 1991 Apr, 106(2), 289 - 95
Endotoxin liberation by strains of N . meningitidis isolated from patients and healthy carriers; Mellado MC et al.; The main objective of this study was to assess whether the capacity of Neisseria meningitidis to release endotoxin depends upon the type of strain or upon bacterial mass . Endotoxin release was studied in 32 strains isolated from patients with meningococcal infections and in 49 from asymptomatic carriers, using a quantitative test (limulus test with a chromogenic substrate) . The results show that the strains from patients release significantly higher amounts of endotoxin than strains from carriers regardless of serogroup and isolation site . No correlation was found between stage of bacterial growth and the amount of endotoxin liberated . These findings suggest that endotoxin liberation is a characteristic of certain strains of N . meningitidis and is not determined simply by bacterial mass.

Epidemiol Infect, 1991 Apr, 106(2), 283 - 8
Effect of penicillin and chloramphenicol on the growth and endotoxin release by N . meningitidis; Mellado MC et al.; The action of two antibiotics, penicillin and chloramphenicol, on bacterial growth and endotoxin liberation was studied in 18 strains of Neissevia meningitidis isolated from blood and CSF of patients with meningococcal infections . The antibiotics were administered both separately and in combined form in doses equivalent to 1 MIC and 100 MIC . Penicillin was found to produce a faster and more intense bactericidal effect than chloramphenicol during the first hour, whereas at 12 h these differences were not significant . This could explain the initial worsening observed in some infected patients when large doses of penicillin are administered . An increased liberation of endotoxin after adding penicillin was observed in six of the strains studied, whereas the remaining 12 did not show significant increases . The six strains (belonging to serogroup B) were known to have an enhanced capacity for spontaneous endotoxin liberation.

South Med J, 1991 Apr, 84(4), 527 - 9
Purpura fulminans and adrenal hemorrhage due to group Y meningococcemia in an elderly woman; Marnejon T et al.; A 70-year-old previously healthy woman was admitted with a 1-day history of malaise, sore throat, nausea, vomiting, rigors, and confusion . She was found to be in septic shock with purpura fulminans and disseminated intravascular coagulation . She died within 36 hours of admission . Blood cultures grew Neisseria meningitidis group Y . Necropsy revealed evidence of shock and bilateral adrenal hemorrhage.

J Postgrad Med, 1991 Apr, 37(2), 76 - 8
Bacteriological study of meningococcal meningitis; Vadher PJ et al.; One hundred and thirty samples of cerebro spinal fluid were collected from patients admitted with suspected signs and symptoms of meningococcal meningitis (M . meningitis) during the period from January 1986 to April 1989 and were processed for gram's staining, cultivation and latex agglutination tests for detection of polysaccharide antigen in the CSF . Totally 41.5% of turbid and hazy spinal fluid were positive for N . meningitidis by smear examination . Only 24.6% were positive by culture but 61.5% of sample were positive by latex agglutination tests . All the strains were sensitive to all antibiotics except one strain which was resistant to penicillin but it was sensitive to rifampicin.

Rev Saude Publica, 1991 Apr, 25(2), 103 - 11
{Occurrence of meningococcal meningitis in a Southern region of Brazil, from 1974 to 1980, using the point event model}; de Gouvea DS et al.; Descriptive statistical techniques and point event model methods were used to investigate the temporal series of cases of meningococcal meningitis which occurred in 100 municipalities in the Rio Grande do Sul State, Brazil, during the period 1974-1980 . The data were grouped by epidemiological state (epidemic or endemic), and separated into 5 groups according to the municipal population . The number of cases of the disease notified weekly was analysed by means of incidence coefficients, with the purpose of studying the epidemic threshold for the state . The time interval between events was analysed in the light of their probability density functions and expected density functions, with the objective of studying the relationship and dependences among events . The analysis of the epidemic threshold suggests that there should not be only one threshold value for detection of outbreak of the disease throughout the state . Analysis of the expected density function extracted from inter-event intervals of the epidemic state showed a correlational structure indicating dependence between events occurring up to 14 weeks apart . No significant correlation for the endemic state, taking as reference model the shuffled version of the original intervals, was observed.

Indian J Pathol Microbiol, 1991 Apr, 34(2), 106 - 11
Enzyme linked immunosorbent assay (ELISA) for detection of meningococcal antibodies in north India; Rao B et al.; Serological response was studied in 16-30 years high risk age group, during the period December 1986-April, 1988, following meningococcal vaccine (Biomerieux, France) . A total of 200 serum samples were collected from 50 individuals before vaccination and at 3 intervals of 1, 3 and 6 months post-vaccination respectively . Antibody response was measured by Enzyme Linked Immuno-Sorbent Assay (ELISA) and indirect haemagglutination assay (IHA) . In the vaccinees antibody response by IHA test showed 56%, 82%, 78% and 74% positivity in the pre-vaccination, 1 month, 3 months and 6 months post vaccination samples . By ELISA 2%, 80%, 74% and 66% of the above groups showed serological response . Difference in the pre-vaccination and titres/O.D . of various post-vaccination groups was found to be statistically significant (p less than 0.001) . There was, however, no significant difference (p greater than 0.05) amongst the titres/O.D . of three post-vaccination groups . Similarly acute and convalescent blood samples of 25 patients and one sample each of 31 contacts was studied for antibody response . In general, higher antibody titres are produced with systemic infection than with local nasopharyngeal infection or following vaccination.

Lancet, 1991 Mar 2, 337(8740), 514 - 7
Point mutation in meningococcal por A gene associated with increased endemic disease; McGuinness BT et al.; The por A gene, which encodes expression of meningococcal class 1 outer membrane protein, responsible for antigenic subtype specificity, has been cloned and sequenced in an isolate of Neisseria meningitidis (B:15:P1.7,16) from a patient in the Gloucester area with meningococcal meningitis . Comparison of the sequence with that of the equivalent gene from the P1.7,16 reference strain reveals a point mutation which generates a single aminoacid change in the epitope responsible for P1.16 specificity . Monoclonal antibodies with P1.16 specificity do not react with synthetic peptides that correspond to the altered epitope, and do not promote complement-mediated bactericidal killing of the isolate . Analysis of other strains shows widespread distribution of infections due to B:15:P1.7,16 meningococci with the altered epitope (P1.16b) in England and Wales.

Int J Epidemiol, 1991 Mar, 20(1), 290 - 2
Inclusion of laboratory test results in the surveillance of infectious diseases; Dominguez A et al.; We studied certain indicators of the speed with which infectious diseases were notified and epidemiological case records carried out by public health workers for notifications with and without inclusion of laboratory test results . The notification records for brucellosis, dysentery, typhoid fever, viral hepatitis, meningococcal meningitis, and pulmonary tuberculosis in the province of Barcelona between 1982 and 1986 have been reviewed . For each disease notified the time lapse between the onset of symptoms and notification (Delay 1), between notification and implementation of the epidemiological investigation (Delay 2), and the sum of both time lapses (Delay 3) were calculated . In all diseases (with the exception of meningococcal meningitis) when significant differences in delays were noted, the longest were found in those notifications that included laboratory data in the epidemiological investigation . This means that the provision of laboratory data makes the process of notification slower (Delays 1, 2, and 3) . Both notification when laboratory results are available and the inclusion of laboratory data in the epidemiological investigation, have a negative influence on the speed of the statutory notification process.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Mar, (3), 41 - 4
{The immunological status indices of monkeys inoculated with a meningococcal B vaccine}; Krasnoproshina LI et al.; The method for the determination of bacterial antibodies to group B meningococci was worked out . The method was used for the determination of antibodies to group B meningococcal vaccine produced in the USSR . The dynamic study of antibodies to protein, polysaccharide and lipopolysaccharide antigens of group B meningococci was made by the method of the enzyme immunoassay (EIA), and the safety of the vaccine was studied by the determination of autoantibodies active against brain tissue antigens . The data thus obtained were indicative of the immunological activity of group B protein-polysaccharide vaccines, manifested by the capacity for stimulating bactericidal antibodies whose level increased 8- to 10-fold after the immunization of monkeys in 2 and 3 injections . Similarity in the dynamics of the formation of bacteriolysins and antibodies to protein antigen, as determined in EIA, was noted . The vaccine was found to stimulate no cytotoxic anticerebral antibodies in the glia migration test, which was indicative of the safety of group B meningococcal vaccine.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Mar, (3), 19 - 21
{The adhesive properties of meningococci from serogroups A, B and C}; Rumiantsev SN et al.; The adhesive properties of 261 meningococcal strains have been studied by the methods of the hemagglutination test, the test of adhesion on buccal epithelial cells and electron microscopy . The study has revealed that adhesive properties can be observed in the strains of all groups under study (A, B and C) isolated from patients and carriers, including those isolated from the nasopharynx, blood and liquor, adhesive properties occurring in newly isolated strains with greater frequency than in museum ones . The simultaneous use of all three above-mentioned methods increases the possibility of the detection of meningococcal strains with adhesive activity.

Enferm Infecc Microbiol Clin, 1991 Mar, 9(3), 165 - 7
{Adhesiveness in Neisseria meningitidis . A virulence factor?}; Mellado MC et al.; The role of adhesivity as a factor of virulence in cases of N . meningitidis has not yet been established . Unlike other bacteria in which the presence of adhesivity reflects an enhanced virulence, a high capacity of adherence is associated with a low virulence and invasive capacity in cases of meningococcus . In order to gain more insight into the knowledge of this phenomenon we have studied the adhesivity of 109 strains of N . meningitidis to human pharyngeal epithelial cells . Twenty nine out of the 109 strains were isolated from blood or spinal fluid of patients with meningococcal infection (meningitis or septicemia), whereas the remaining 80 strains were obtained from pharyngeal smears of healthy carriers . The adhesivity was measured as the number of meningococci adhered to 50 epithelial cells according to Craven's scale . Strains of healthy carriers showed a greater adhesivity than that of patients (p less than 0.001) . The relevance of the pharyngeal area in the evaluation of the adhesive capacity is in accordance with the hypothesis that meningococcal adhesivity decreases when the microorganism crosses the pharyngeal epithelium . The results would support the concept that the virulence of N . meningitidis is related to its adhesiveness.

Mol Microbiol, 1991 Mar, 5(3), 727 - 36
Comparison of the class 1 outer membrane proteins of eight serological reference strains of Neisseria meningitidis; Maiden MC et al.; Primers suitable for the amplification of the gene encoding the class 1 outer membrane protein of Neisseria meningitidis by the polymerase chain reaction (PCR) were designed from published DNA sequences and used to study the gene in eight meningococcal strains of different serogroup, serotype and subtype . At high annealing stringency one product, shown to correspond to the class 1 protein gene, was amplified from each strain . For three strains an additional smaller product, provisionally identified as the gene encoding the class 3 outer membrane protein, was amplified at lower annealing stringencies . Nucleotide sequence analysis of the PCR products corresponding to the class 1 proteins established the differences in the primary structure of the proteins between each of the subtypes and other outer-membrane proteins from Neisseria spp . These differences impose constraints on possible structural models of these proteins . Most amino acid sequence variation occurred in two domains of between 8 and 17 amino acids; there was an additional region which varied mainly between classes of outer membrane protein and there were nine conserved regions . Using appropriate primers it was possible to distinguish between class 1 outer membrane protein genes from strains of different subtypes by the PCR.

Clin Exp Immunol, 1991 Mar, 83(3), 460 - 5
Clonotypic analysis of human antibodies specific for Neisseria meningitidis polysaccharides A and C in adults; Le Moli S et al.; Serum antibodies to the capsular polysaccharides A and C (PSA and PSC) of N . meningitidis in healthy adults before and after vaccination with the sole polysaccharides were analysed by isoelectric focusing (IEF) . Before vaccination, 49% and 28% had naturally acquired antibodies against PSA and PSC, respectively, whereas 18 days after vaccine administration 84% and 91%, respectively, showed a detectable spectrotypic pattern . Oligoclonality appeared to be the main feature of naturally acquired and vaccine-induced antibodies for both polysaccharides . In all subjects the anti-PSA response, showing dominant bands at the same pH position, was more homogeneous than anti-PSC one . Most subjects with naturally acquired antibodies (25 out of 38 for PSA and 20 out of 22 for PSC) showed a spectrotypic pattern after vaccination, similar to that observed before vaccination (any differences were just related to band intensity), suggesting that PSA and PSC are able to recruit the same B cell clones previously primed with a T-dependent form of the antigen, i.e . the whole bacterium . However, in one-third of subjects with naturally acquired anti-PSA antibodies, the appearance of new alkaline bands after vaccination was observed . Furthermore, in subjects with absence of detectable natural antibodies, the vaccine-induced antibody response started in correspondence of alkaline pH areas, subsequently extending to neutral and acidic areas . Therefore, it may be hypothesized that alkaline antibody-secreting B cell clones are the first to be recruited . The final spectrotype in these subjects was similar to that observed in subjects with naturally acquired antibodies . This observation, together with the above reported data, allow us to conclude that natural (T-dependent pathway) and vaccine (T-independent pathway) immunization induce the expression of the same antibody repertoire, for both meningococcal PSA and PSC.

Infect Immun, 1991 Mar, 59(3), 843 - 51
Preparation, characterization, and immunogenicity of meningococcal immunotype L2 and L3,7,9 phosphoethanolamine group-containing oligosaccharide-protein conjugates; Verheul AF et al.; A method was developed for the well-defined coupling of phosphoethanolamine group (PEA)- and carboxylic acid group-containing polysaccharides and oligosaccharides to proteins without the need for extensive modification of the carbohydrate antigens . The carboxylic acid group of the terminal 2-keto-3-deoxyoctulosonic acid moiety was utilized to introduce a thiol function in meningococcal immunotype L2 and L3,7,9 lipopolysaccharide-derived oligosaccharides . The thiol group-containing oligosaccharides were subsequently coupled to bromoacetylated proteins . Immunotype L2 and L3,7,9 PEA group-containing oligosaccharide-tetanus toxoid conjugates were prepared, and their immunogenicities were studied in rabbits . Both the immunotype L2 and immunotype L3,7,9 conjugates evoked high immunoglobulin G (IgG) antibody titers after the first booster injection . These conjugates also displayed an ability to induce long-lasting IgG antibody levels which could be detected until 9 months after one booster injection at week 3 . The adjuvant Quil A enhanced the immune response to all the conjugates to a minor extent, which is in contrast with reported adjuvant effects of Quil A on these types of antigens in mice . A conjugate prepared from the dephosphorylated L3,7,9 oligosaccharides evoked a significantly lower IgG response than a similar PEA-containing conjugate, and enzyme-linked immunosorbent assay inhibition studies indicated a different epitope specificity . Furthermore, antisera elicited with the complete bacteria contained antibodies directed against PEA-containing epitopes, which stresses the importance of the presence of unmodified PEA groups in meningococcal lipopolysaccharide-derived oligosaccharide-protein conjugates . The procedure developed offers an elegant solution for the specific coupling of meningococcal PEA-containing oligosaccharides to proteins and may therefore be a very useful tool in the development of a vaccine against group B meningococci.

Rev Sanid Hig Publica (Madr), 1991 Mar-Apr, 65(2), 127 - 35
{Clinical-epidemiological assessment of bacterial meningitis in the province of Cordoba (1983-1989)}; Fernandez-Crehuet Navajas R et al.; 533 cases of bacterial meningitis diagnosed in the province of Cordoba over a period of seven years are analyzed . 53.7% of the cases are in males, with 71.2% of the cases being detected in children under 14 (p less than 0.001) . Greater incidence has been observed in Cordoba city than in the province, with a direct relationship being between morbidity and population density . The months with lower average temperature account for 45.6 por 100 of all the diagnosed cases of meningitis . By etiology, 51.9% were meningococcal meningitis, followed by meningitis produced by unknown germs (35.3%) and by H . influenzae . The illness developed in 91.3% of cases to a cure, with sequelae in 4.1% and death in 4.4% . Meningitis produced by H: influenzae was what caused most sequelae and that produced by S . pneumoniae was the most lethal . Isolated N . meningitidis presented 100% sensitivity to penicillin and cephalosporins, H . influenzae 91.7% chloramphenicol and only 28.3% to penicillin.

Ugeskr Laeger, 1991 Feb 11, 153(7), 509 - 12
{Purulent meningitis in childhood . Treatment results in 87 children between 7 month and 15 years of age}; Madsen LP et al.; The children were admitted over a 14-year period (1975-1988) from an admission area of average Danish population distribution . The incidence was 15.5/100,000 children per year . The area had endemics of meningococcal disease in the years 1983-1984 . The etiology was meningococcal in 43%, Hemophilus influenzae in 33% and pneumococci in 9% of the patients . Regardless of etiology, the antibiotic schedule was ampicillin 400 mg/kg body weight/day . Resistance to ampicillin was not found in any of the bacterial cultures . Within two weeks before admission 59% of the children had experienced a febrile illness . The diagnosis of meningitis was missed before admission in 24% of the cases . On admission, 93% had typical clinical signs of meningitis . 87% were lethargic or comatose . 31% had convulsion and in 13% the peripheral circulation was compromised . Recrudescence was suspected in one patient . Sequelae were most commonly found in children with meningococcal meningitis and were persistent in 23% of all the children . Severe or less severe neurological handicaps were seen in 29% (psychomotor retardation, epilepsy, cerebral palsy and hearing loss) . One patient with Waterhouse-Friederichsens syndrome died . Thus the overall mortality was 1.2%, which is low compared to treatment results reported by others.

Vrach Delo, 1991 Feb, (2), 57 - 60
{The characteristics of the course of suppurative meningitis in children}; Vereshchagin IA et al.; The clinical course of meningitides of different etiology was studied in 135 children . In meningitis of non-meningococcal etiology there is a prevalence of forms with brain involvement (meningoencephalitis) that are characterized by a prolonged intoxication, protracted course and residual sequels . The clinical diagnosis is difficult and requires bacteriological and serological examinations.

J R Coll Surg Edinb, 1991 Feb, 36(1), 11 - 2
Amputation for gangrene of the limbs following severe meningococcal infection; Landham TL et al.; Five cases of severe meningococcal infection in children and young adults with gangrene leading to major amputation are described . They are associated with necrosis of the skin and soft tissue, intravascular coagulation and shock . The surgical options, prosthetic implications and the consequent rehabilitation outcome are discussed.

Am J Epidemiol, 1991 Feb 1, 133(3), 286 - 95
Risk factors for carriage of meningococcus in the Los Angeles County men's jail system; Thomas JC et al.; Ten cases of meningococcal meningitis in the Los Angeles County men's jail system in 1986 were the first known reported cases in this population . New cases have continued into 1990 . Nineteen of 21 symptomatic cases identified by serogroup from the men's jail occurring through 1988 had serogroup C . The prevalence of meningococcal carriage and potential risk factors were studied in 1988 among 150 men booked to enter the jail, 350 inmates being released, and 100 jail staff . The prevalence of meningococcal carriage among releases, bookings, and staff were 25.4%, 18.7%, and 5.0%, respectively . Among releases, imprisonment longer than a threshold of 28 days increased carriage of serogroup C 10.0 times (95% confidence interval (CI) 4.6-21.6) . Among bookings, household crowding increased serogroup C carriage 8.2 times (95% CI 1.5-45.3) . Direct and passive smoking at home increased carriage of any serogroup 5.2 (95% CI 1.2-47.5) and 2.5 (95% CI 1.1-5.8) times, respectively . Feasible potential interventions include banning smoking in the jail and immunization with quadrivalent meningococcal vaccine of booked men sentenced for one month or more.

J Trop Med Hyg, 1991 Feb, 94(1), 8 - 14
Development of a protocol for early treatment of endemic meningitis in children in Vanuatu; Harris M et al.; Meningitis is endemic in Vanuatu and other Pacific island countries and has a high case fatality rate . The incidence in the southern island of Tanna is especially high . This descriptive study of 64 cases in children (under 15 years) on that island was undertaken over a 21-month period from January 1988 to September 1989 . Meningococcus was identified in 23 cases (36%) and Pneumococcus in 12 (19%) . The age distribution showed a high rate in under 1 year olds . The symptoms of fever, convulsion and vomiting were most common . Bulging fontanelle (in children under 1 year), neck rigidity, and altered level of consciousness were the most frequent signs . These signs were as frequent in meningococcal as pneumococcal infections and were used to develop a simple protocol for use in primary care . Delay in treatment or referral because of patients seeking traditional medicine is a major problem yet to be overcome . Only a weak association between admissions with meningitis and underweight or crowding was found in this study.

Am J Dis Child, 1991 Feb, 145(2), 218 - 20
Factors affecting outcome in meningococcal infections; Tesoro LJ et al.; A prognostic score for evaluating meningococcal infections in patients consists of the following five features that indicate a poor prognosis: onset of petechiae within 12 hours of presentation; shock; normal or low peripheral leukocyte count; normal or low erythrocyte sedimentation rate; and absence of meningitis . Based on our experience and some published data, we suspected that the score may no longer be reliable . We reviewed the charts of 73 children with meningococcal infection from December 19, 1979 to December 19, 1987 and applied the prognostic score mentioned previously . Our findings indicate that although a low score is generally associated with a good outcome, a higher score is less predictive of poor outcome than previously suggested . A rash with petechiae or purpura, the presence of shock, and a normal or low peripheral leukocyte count continue to be predictors of poor outcome . Erythrocyte sedimentation rate was not evaluated owing to a limited amount of data . The absence of meningitis did not correlate with a worse outcome in our patients . Most patients who died had evidence of meningeal involvement at the time of presentation . Instead, altered mental status at presentation, particularly obtundation or coma, was an ominous sign . We conclude that absence of meningitis is not a good predictor of outcome, as was previously thought . Altered mental status at the time of presentation may prove to be a stronger indicator of poor outcome.

Arch Intern Med, 1991 Feb, 151(2), 310 - 6
Adult overwhelming meningococcal purpura . A study of 35 cases, 1977-1989; Giraud T et al.; The study objective was to describe the clinical, biologic, and hemodynamic features of adult overwhelming meningococcal purpura and to examine the prognostic factors by multivariate analysis at the time of admission to the intensive care unit . Thirty-five patients (greater than or equal to 13 years of age) with meningococcal infection, circulatory shock, and generalized purpuric lesions of abrupt onset were recorded in eight intensive care units from 1977 to 1989 . The patients were young (mean age, 26.6 years; range, 13 to 68 years) and had been previously healthy . The female-to-male ratio was 3:1 . Mortality was 54.3%, with most deaths occurring within the first 48 hours, usually secondary to irreversible shock with multiple organ failure . Ischemic complications (eight cases), prolonged heart failure (seven cases), and secondary septicemia (five cases) were the chief complications among survivors . Initial hemodynamic study after volume loading showed low stroke volume index (mean +/- SD, 29.4 +/- 13 mL/m2) and tachycardia (mean +/- SD, 138 +/- 16 beats per minute), a profile suggesting a greater myocardial depression than usually observed in gram-negative bacillary septic shock . Univariate prognostic analysis showed that four variables at the time of admission were associated with fatal outcome: a plasma fibrinogen level of 1.5 g/L or less, a factor V concentration of 0.20 or less, a platelet count lower than 80 x 10(9)/L, and a cerebrospinal fluid leukocyte count of 20 x 10(6)/L or less . Stepwise regression analysis showed that low fibrinogen level (less than or equal to 1.5 g/L) was the sole adverse prognostic variable (odds ratio = 2, 95% confidence interval, 1.5 to 2.7) . Adult overwhelming meningococcal purpura is still associated with high mortality and morbidity . Low fibrinogen level at time of admission may permit early recognition of the most severely ill patients.

Epidemiol Infect, 1991 Feb, 106(1), 143 - 50
Genetic relationships among strains of Neisseria meningitidis causing disease in Italy, 1984-7; Mastrantonio P et al.; Since 1984 a change in the epidemiological pattern of meningococcal disease in Italy has occurred with a predominance of Neisseria meningitidis of serogroup C (76%), serotype 2a and a high proportion of strains resistant to sulphonamides (71%) . In order to understand better the epidemiology of the group C N . meningitidis strains responsible for the disease over the last years in Italy, we studied the genetic features of phenotypically closely related strains, by enzyme electrophoresis . The results showed that the genetic and the phenotypic characteristics of the 57 strains studied were similar, suggesting that spread of a single clone during recent years in our country . This result is in agreement with the circulation of strains typical of epidemic situations, despite the decreasing incidence of meningococcal disease in Italy.

Epidemiol Infect, 1991 Feb, 106(1), 133 - 41
Meningococcal carriage in close contacts of cases; Cartwright KA et al.; Between 1 October 1986 and 31 March 1987, 55 cases of meningococcal disease were identified in the South-West of England, an attack rate of 1.54 per 100,000 during the study period . Antibiotics used in the treatment of the disease successfully eliminated nasopharyngeal carriage of meningococci in 13 out of 14 cases without use of rifampicin . The overall meningococcal carriage rate in 384 close contacts was 18.2% and the carriage rate of strains indistinguishable from the associated case strain was 11.1% . The carriage rate of indistinguishable strains in household contacts (16.0%) was higher than the carriage rate in contacts living at other addresses (7.0%, P less than 0.05) . A 2-day course of rifampicin successfully eradicated meningococci from 46 (98%) of 47 colonized contacts . In one third of cases groupable meningococci were isolated from at least one household contact; 92% of these isolates were of the same serogroup as the associated case strain . When a meningococcus is not isolated from a deep site in a clinical case of meningococcal disease, culture of serogroup A or C strains from nasopharyngeal swabs of the case or of household contacts is an indication that the close contact group should be offered meningococcal A + C vaccine in addition to chemoprophylaxis . The failure in this and other studies to isolate meningococci from any household contact in the majority of cases may be due either to the relative insensitivity of nasopharyngeal swabbing in detecting meningococcal carriage or to the acquisition of meningococci by most index cases from sources outside the household.

MMWR Morb Mortal Wkly Rep, 1991 Jan 25, 40(3), 46 - 7, 55
Laboratory-acquired meningococcemia--California and Massachusetts; Clinical manifestations in humans of combined C7 and C4 deficiency associated with low levels of C2 et al.; Department of Internal Medicine, University of Bern, Switzerland64 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.

Pediatr Med Chir, 1991 Jan-Feb, 13(1), 91 - 3
{Meningococcal sepsis and DIC in childhood: a report of a clinical case}; Carnelli V et al.; Disseminated intravascular coagulation (DIC) is a frequent complication of meningococcal sepsis in children . The clinical course variability, the severity of manifestations and the need of an early diagnosis for appropriate treatment, guides us to report a case of meningococcal sepsis and DIC . The patient, male, prematurely born, 11 months years old, presented himself with high fever of sudden onset, malaise, diarrhea, diffuse skin rash with abdominal petechiae, and no clinical evidence of meningitidis . Initial hematochemical findings, peripheral leukocytosis, quantitative and qualitative changes in plasma coagulation factors, liquoral hypocellularity together with the development of signs of meningeal irritation (stiff neck and back) were considered diagnostic clues for meningococcal sepsis associated with DIC . A gram-negative diplococcus was cultured from liquor . Primary goals of the treatment of this life-threatening clinical picture were the elimination of the bacterial component, the correction of clotting disorders and careful control of shock and metabolic acidosis often related with DIC . The patient then received a wide spectrum Cephalosporin, fresh frozen plasma, appropriate electrolyte solutions and eventually heparin, which led to a complete control and resolution of symptomatology.

Gac Sanit, 1991 Jan-Feb, 5(22), 29 - 33
{Evaluation of the information provided by the system of compulsory notification of diseases}; Dominguez Garcia A et al.; In order to assess activities of epidemiological surveillance resulting from the statutory notification system, a total of 17,394 notification records of eight infectious diseases (brucellosis, bacillary dysentery, typhoid fever, viral hepatitis, meningococcal infection, rickettsioses other than exanthematous typhus, pulmonary tuberculosis, and tuberculosis of other organs) together with 10,503 epidemiological surveys submitted to the "Servei Territorial de Salut Publica" of the province of Barcelona between 1982 and 1986 were reviewed . In notification records, data to locate physicians were the most commonly found (between 92.6% and 99.4% according to disease), whereas in epidemiological surveys, clinical and analytical data were the most frequently encountered . The inclusion of data of epidemiological interest ranged from 3.6 to 68.6% . In order to improve efficacy of the statutory notification system a proposal is made to reduce the extension of epidemiological surveys in terms of requesting only necessary data to establish appropriate measures in each case.

An Esp Pediatr, 1991 Jan, 34(1), 57 - 61
{Renal function in meningococcal infection . Analysis of 116 cases}; Mar Molinero F et al.; We study the renal function in meningococcal sepsis in other to get prognostic data in disease evolution . We include 116 patients of whom we take data of anamnesis; physical examination; blood, urine and cerebrospinal fluid biochemical and microbiologic studies and TISS and APS score . We analyze qualitative and quantitative data of renal function statistical and we compare with another prognostic data of disease . We find that renal failure in meningococcal sepsis gets worse the prognostic of the disease.

Rev Infect Dis, 1991 Jan-Feb, 13 Suppl 2, S170 - 3
Chemoprophylaxis for bacterial infections: principles of and application to meningococcal infections; Schwartz B; Chemoprophylaxis with antibiotics is both feasible and desirable for prevention of a potentially serious disease when specific groups at risk can be defined and when a safe, effective, and affordable prophylactic agent is available . Although the Advisory Committee on Immunization Practices recommends rifampin for prophylaxis of meningococcal disease, there are failures of treatment and adverse reactions associated with the administration of this drug, and it cannot be used during pregnancy . In 1987, during an outbreak of group A meningococcal disease in Saudi Arabia, the efficacy of a single intramuscular dose of ceftriaxone was compared with the standard regimen of rifampin for eradication of pharyngeal carriage of Neisseria meningitidis among persons at risk . Follow-up cultures indicated successful eradication for 97% of those who received ceftriaxone and 75% of those who received rifampin . Thus, although ceftriaxone exceeds rifampin in fulfilling the criteria for an effective prophylactic agent, recommendations regarding its use still must be made with caution because of limited clinical experience.

Allergol Immunopathol (Madr), 1991 Jan-Feb, 19(1), 39 - 41
Serum antibodies to capsular polysaccharide vaccine of group A and C Neisseria meningitidis in military recruits in Italy; Occhionero M et al.; In this study we evaluated, by a standard bactericidal assay, the antibody response to the meningococcal group A and C polysaccharide vaccine used for the immunization programme of the Italian military recruits, compulsory by law since 1987 . The percentage of responders, those who developed a four-fold increase in the bactericidal titre to polysaccharide A and C, was 96% and 98%, respectively . No significant side effects were observed after vaccination.

Ir J Med Sci, 1991 Jan, 160(1), 10 - 1
Adult respiratory distress syndrome (ARDS) complicating meningococcaemia; Wilson DC et al.; We describe a one year old boy with meningococcaemia complicated by the adult respiratory distress syndrome . Maintenance of oxygenation required a positive end-expiratory pressure of 20 cm H2O . Resultant barotrauma produced pneumothorax and pneumomediastinum . Prompt recognition and treatment of this complication can reduce its high mortality rate.

Zh Mikrobiol Epidemiol Immunobiol, 1991 Jan, (1), 12 - 6
{The effect of the iron content in the culture medium on the nature of the protein spectrum in Neisseria meningitidis}; Filatova TN et al.; The protein spectra of Neisseria meningitidis, strain A 208, in the process of its cultivation on solid culture medium based on peptone agar under the conditions of the surplus or deficiency of ions of trivalent iron in the medium . The creation of iron deficiency by the introduction of two iron-binding admixtures, desferol and diethylenetriaminepentaacetic acid (DTPA), was found to lead to the production of two additional proteins with molecular weights of 72 kD and 36-37 kD by meningococcal cells . Of these two admixtures, DTPA more readily stimulated the production of low-molecular protein with a molecular weight of 36-37 kD . This protein was found to be noticeably labile, while protein with a molecular weight of 72-73 kD showed no such lability . As the result of the cultivation of meningococci in iron-deficient medium, the content of protein in microbial residue was 2- to 3-fold greater than that obtained by the cultivation of meningococci in culture medium with the surplus of iron in the form of ferric nitrate.

Scand J Infect Dis, 1991, 23(2), 171 - 4
Neisseria meningitidis with reduced sensitivity to penicillin: observations in 10 children; Uriz S et al.; 10/84 strains (11.9%) of Neisseria meningitidis isolated from blood and/or cerebrospinal fluid in children 1986-1987 had reduced sensitivity to benzylpenicillin (MICs 0.1-0.4 mg/l) . Group C meningococci predominated among these strains . The clinical course was satisfactory in all cases regardless of the antibiotic treatment used, although the time to abatement of fever was prolonged compared to that of children infected with susceptible strains.

Biologicals, 1991 Jan, 19(1), 41 - 7
Control of components of bacterial polysaccharide vaccines by physical methods; Jones C et al.; Analysis of polysaccharide components of meningococcal- and pneumococcal vaccines was carried out by proton n.m.r . spectroscopy and gas chromatography . The meningococcal polysaccharides were of high purity but showed differences in degree and position of O-acetylation between manufacturers . The level of contamination of the pneumococcal polysaccharides by C-substance was quantified . These methods provide an alternative to immunological methods for determining serotype and purity.

Crit Care Med, 1991 Jan, 19(1), 26 - 30
Validation of the Glasgow Meningococcal Septicemia Prognostic Score: a 10-year retrospective survey; Thomson AP et al.; OBJECTIVE: To derive performance characteristics for the Glasgow Meningococcal Septicemia Prognostic Score (GMSPS) . DESIGN: Retrospective case-note study . SETTING: Two children's hospitals with Regional Intensive Care Unit . PATIENTS: One hundred twenty-three children with proven meningococcal septicemia (some with concurrent meningitis) from January 1, 1977 to December 31, 1986 . MEASUREMENTS AND MAIN RESULTS: All 14 children who died after arrival scored greater than or equal to 8 either on admission (n = 8) or afterward (n = 6) . Of 109 survivors, five scored greater than or equal to 8 (two were postictal at the time of scoring) . A GMSPS of greater than or equal to 10 at or after admission predicted death with sensitivity 100%, specificity 98%, and positive predictive value of 88%; for GMSPS of both greater than or equal to 8 or 9, the values were 100%, 95%, and 74%, respectively . CONCLUSIONS: The GMSPS is a rapid clinical score that performs well in identifying children with poor prognosis who might benefit from early intensive care . It should be studied prospectively and compared with other scoring systems.

Rev Hosp Clin Fac Med Sao Paulo, 1991 Jan-Feb, 46(1), 1 - 8
{Arteritis dependent on infective process: the convenience of heparin use}; Langer B et al.; Twenty patients with peripheral arteritis due to an infectious disease were studied with the purpose to detect the etiological agent in the vessels belonging to ischemic areas; to establish the relationship between the onset and evolution of the ischemic lesions and the infectious disease; and to verify the appropriateness of the treatment with anticoagulants . Ten patients had meningococal disease with positive blood culture for Neisseria meningitidis . The meningococci were found in vessel walls of ischemic areas . The cutaneous lesions had sudden onset and a rapid evolution . Five patients had pneumonia or gastroenteritis . No microorganisms were detected in the vessel walls of the ischemic areas . The cutaneous necrotic lesions appeared from two to six days after the infectious disease was diagnosed . Therefore, heparinization was considered appropriate to block the extension of the disseminated intravascular coagulation secondary to the vasculitis . Three patients had, probably, post-streptococcal sensibilization arteritis and two post-measles arteritis . No etiological agent was identified in the vessel walls . The necrotic lesions of the extremities appeared from five to 21 days after the clinical course of the infection . The lesions had the complete evolution in a period from one to four days . It was considered appropriate to start the heparinization in the evolutive period of the peripheral lesions in an attempt to reduce the ischemia by the interruption of the intravascular coagulation related to the vasculitis . In heparinized patients in whom the necrotic lesions did not extend completely in the extremities, the evolution to irreversible gangrene and limb loss did not occur.(ABSTRACT TRUNCATED AT 250 WORDS)

J Acquir Immune Defic Syndr, 1991, 4(2), 188 - 96
Immunologic parameters in early-stage HIV-seropositive subjects associated with vaccine responsiveness; Birx DL et al.; Twenty-one asymptomatic HIV-seropositive subjects and 20 HIV-seronegative controls were assessed for their serologic response to multiple live attenuated viral, protein (toxoid), and polysaccharide vaccine antigens . Extensive in vivo and in vitro immunologic evaluations were performed . Factors predictive of immunogen responsiveness by HIV-seropositive patients were found by correlating vaccine responses with results of T- and B-cell functional assays . Eleven HIV-seropositive patients (HIV nonresponsive-NR) responded to only one of three vaccines used for analysis (meningococcus, group C; adenovirus 4, 7; and diphtheria-tetanus) compared with the normals, of whom 100% responded to two or more of the same immunogens . Ten HIV-seropositive patients (HIV responsive-R) responded equivalently to normals . The HIV NR group had distinctive immunologic abnormalities predictive of their poor immunogen responsiveness . These included defects in the T-cell helper function despite normalization of T cell number and defective T-cell suppression of Epstein-Barr virus (EBV) in vitro (HIV NR, 30% suppression; HIV R, 73% suppression; and normals, 95% suppression of EBV-driven immunoglobulin production in vitro) . The B cells of the HIV NR groups were also abnormal in vivo . The HIV NR patients' B cells were larger and had increased native response to B-cell growth factor evidenced by increased thymidine incorporation . (HIV-NR, 10,232 +/- 3,003 cpm; HIV R, 5,432 +/- 1,125; normal, 402 +/- 11 . HIV NR/HIV R, p less than 0.05; HIV NR/N, p less than 0.001.)(ABSTRACT TRUNCATED AT 250 WORDS)

Scand J Infect Dis, 1991, 23(6), 723 - 30
Epidemiology of meningococcal disease in Denmark 1980-1988; Samuelsson S et al.; Based on epidemiological data of notified cases of meningococcal disease (MD) in Denmark during the period 1980-88 the recommendations for prophylaxis are evaluated . In 1986 the incidence of MD increased about 60% to 5.5 per 100,000 population . The clinical diagnosis of MD was verified by culture of Neisseria meningitidis in 79% of notified cases . About 40% of all patients were less than 4 years of age . The mortality in 1988 was found to be 10% . Serogroup B disease accounted for about 80% of the cases . Two co-primary and 28 secondary cases were registered . Two major outbreaks of serogroup C disease occurred in 1984 and 1986, respectively . In small clusters of 2-3 cases within socially well-defined groups the recommendations for prophylaxis are sufficient . But for the new pattern of clusters spread over months to years in certain geographical areas or open social groups, especially among teenagers, the existing recommendations are insufficient . The occurrence of localized clusters of serogroup B disease emphasises the need for a vaccine against serogroup B disease.

Am J Nephrol, 1991, 11(5), 411 - 5
Bilateral renal cortical necrosis in two patients with Neisseria meningitidis sepsis; Chervu I et al.; Two patients who developed bilateral renal cortical necrosis as a consequence of Neisseria meningitidis infections are described: 1 patient had meningococcemia and the other had meningococcal meningitis . Both patients developed a Shwartzman-like reaction, disseminated intravascular coagulation and irreversible renal failure . Renal biopsy showed sclerosis of the majority of glomeruli; some glomeruli showed capillary congestion, thrombosis and an increased number of neutrophils; the intralobular arterioles showed thrombotic occlusions.

Trans R Soc Trop Med Hyg, 1991, 85 Suppl 1, 4 - 5
Epidemiology, prevalence and clinical diagnosis of meningitis at Abbassia Fever Hospital, Cairo, 1966-1989; Kilpatrick ME et al.; The United States Naval Medical Research Unit No . 3 and the Abbassia Fever Hospital in Cairo, Egypt have together diagnosed and treated 7809 patients admitted to a meningitis ward since 1966 . Aetiological diagnosis was based on clinical evaluation and laboratory studies . Marked increases in annual admissions in 1970-1972, 1980-1982 and 1987-1988 were related to increases in admissions due to meningococcal disease, while in 1977-1981 the increase was due to encephalitis related to Rift Valley fever . Better, rapid diagnostic procedures are needed to enable effective treatment to be given earlier and to reduce mortality rates.

Trans R Soc Trop Med Hyg, 1991, 85 Suppl 1, 37 - 43
Meningococcal vaccines--present and future; Zollinger WD et al.; Over 20 years after the development of the meningococcal A and C vaccines, an effective vaccine against Neisseria meningitidis group B is still lacking . Major obstacles in the development of a B vaccine have been the remarkable capacity of the organism to evade the immune defences of the host and the lack of a predictive animal model . Three group B vaccines based on outer membrane proteins have been, or are currently being, evaluated in field trials . Nevertheless, a number of important questions remain such as the identity of the active components, the degree of efficacy against heterologous group B subtypes, and the duration of protection . In addition, work on a variety of alternative approaches to a group B vaccine is rapidly progressing . Among these are use of chemically modified group B polysaccharide, synthetic or natural lipopolysaccharide epitopes, synthetic peptides corresponding to bactericidal epitopes on the class 1 outer membrane protein, and iron binding proteins . Although each of these approaches has some problems associated with it, the prospects remain good for an effective solution to the group B problem.

Trans R Soc Trop Med Hyg, 1991, 85 Suppl 1, 24 - 31
Clonal properties of meningococci from epidemic meningitis; Achtman M; Methods from the field of population genetics now enable the classification of epidemic strains of Neisseria meningitidis and have resolved the relationships between apparently distinct epidemics . The diversity of serogroup A bacteria seems quite limited and only a few strains have been responsible for the epidemics of recent decades . Meningococci express both constant and highly variable antigens, the variability of which is determined by the clonal background of the epidemic strain . The development of an improved vaccine is being pursued but still faces technical problems.

Scand J Plast Reconstr Surg Hand Surg, 1991, 25(3), 291 - 3
Transplantation of cultured autologous epithelium after meningococcal septicaemia in a 4-year-old with 35% skin loss; Kjartansson J et al.; A 4-year-old girl with scattered full-thickness skin and soft tissue wounds mainly on the extremities and corresponding to roughly 35% of the total body surface area was treated with early excision and transplantation of cultured autologous epidermal grafts . The transplantation was accomplished in one stage, three weeks after admission . The epidermal cells were cultured in Stockholm, Sweden and the time of transportation of the grafts to Reykjavik, Iceland (seven hours) did not seem to affect the quality, as 85% had taken one week after transplantation . The patient healed completely without further transplantation, but a few local skin flaps were needed to cover exposed articular surfaces . The patient was discharged from hospital with stable grafts five weeks after transplantation.

Dev Biol Stand, 1991, 73, 323 - 7
Safety follow-up in a cohort of Biken acellular DPT vaccine recipients in Japan; Chazono M et al.; In October 1984 in Sweden, a phase II trial of Biken acellular Pertussis vaccine was started and in 1986, a phase III trial of the same vaccine was begun . During the phase III trial, there were three cases of deaths out of 1,385 of study children at two, four and ten weeks after the second dose of the vaccine, due to severe invasive bacterial infections such as H . influenzae, Pneumococcus, or Meningococcus infection . A number of arguments arose about the results of the Phase III trial . No one can either prove or disprove the association between invasive bacterial infection and administration of acellular pertussis vaccine . The purpose of this paper is to discuss the side effects of Biken acellular DPT vaccine . The pediatricians inquired about the physical status of the children who received Biken acellular DPT vaccine . During the observation period, three out of 940 infants suffered from infectious diseases . One suffered from measles, the other from varicella and the last from mumps . Our retrospective study did not reveal any severe invasive bacterial infection cases cases such as the ones experienced in Sweden.

Trop Geogr Med, 1991 Jan-Apr, 43(1-2), 111 - 3
Evaluation of antibody response in meningococcal patients, contacts and vaccinees in north India; Rao B et al.; Serological response was studied in a high risk age 16-30 years group, during the period December 1986-April 1988, following vaccination with a meningococcal vaccine (Biomerieux, France) . A total of 200 serum samples were collected from 50 individuals before vaccination and at 1, 3 and 6 months post-vaccination respectively . Antibody response was measured by Enzyme Linked Immuno-Sorbent Assay (ELISA) and indirect haemagglutination assay (IHA) . In the vaccinees antibody response by IHA test showed 56%, positivity in the pre-vaccination samples and 82%, 78% and 74% positivity 1 month, 3 months and 6 months in the post-vaccination samples . By ELISA 2%, 80%, 74% and 66% of the above groups showed serological response . Difference in the pre-vaccination and titres/O.D . of various post-vaccination groups was found to be statistically significant (p = 0.001) . There was, however, no significant difference (p = 0.05) amongst the titres/O.D . of three post-vaccination groups . Similarly, acute and convalescent blood samples of 25 patients one sample each of 31 contacts was studied for antibody response . In general, higher antibody titres are produced with systemic infection than with local nasopharyngeal infection or following vaccination.

Trans R Soc Trop Med Hyg, 1991, 85 Suppl 1, 32 - 6
Meningococcal molecular mimicry and the search for an ideal vaccine; Griffiss JM et al.; The carbohydrates expressed on the surface of meningococcal strains of groups B and C mimic those commonly found on human cells and thus are not functionally antigenic in infancy . In order to develop an effective vaccine, it will be necessary to find ways of circumventing this molecular mimicry . Three possible ways of achieving this are discussed . (i) The surface polysaccharides can theoretically present conformationally different epitopes, some of which might be recognized as antigenic by the host . Experimental evidence is presented that such differences do indeed exist; what is needed is to determine which of these conformations are unique to the organism and hence potentially antigenic . (ii) Precursors of the surface lipooligosaccharides may be unable to mimic human antigens, and so may be potential candidates for vaccine development . (iii) Natural immunity to some strains of meningococci develops in young children who are colonized with strains of Neisseria lactamica, and it is possible that its development could be enhanced by widespread intentional colonization by N . lactamica strains that are particularly efficient inducers of broad immunity.

Lab Delo, 1991, (9), 74 - 6
{Evaluation of the coagglutination reaction with urine in generalized forms of meningococcal infection}; Kostiukova NN et al.; The coagglutination test with concentrated urine was tried in 59 patients with validated generalized forms of meningococcal infection and in 23 ones with meningitides and pneumonia of a different etiology to assess the diagnostic value of this test . Positive results were obtained in 64.4% of the test group patient and in 4.3% of the reference patients (in a case with pneumococcal meningitis) . The antigen serologic group in the urine coincided with the serologic group of the meningococcus that induced the disease in only 19 (50%) of the 38 patients in whom antigenuria+ was detected . In the rest cases urine samples reacted parallel with 2-7 antisera, in 5 patients with the antisera heterologic towards the serologic group of the meningococcus responsible for the disease . Antigenuria was observed between the second and ninth days of the illness, its peak was recorded on days 4-6 . Repeated urine tests are more likely to yield positive results . The authors come to a conclusion that the test is simple and harmless for patients, but the presence of false positive results permits regarding it as but an auxiliary one.

Ann Fr Anesth Reanim, 1991, 10(4), 394 - 7
{Purpura fulminans and C7 deficiency complicated by Pneumocystis carinii pneumonia}; Tillant D et al.; A case of meningococcal purpura fulminans is reported in a 22-year-old woman who also suffered from a congenital deficiency in the seventh component of the complement system . This was her third episode of recurrent meningitis . In the course of her treatment in intensive care, the septic shock was cured, but she developed Pneumocystis carinii pneumonia . Histological investigations revealed abnormalities in her T-cell population, with a very low T-helper (CD4) to T-suppressor (CD8) ratio . Laboratory data showed that she did not have any antibodies to HIV.

J Acquir Immune Defic Syndr, 1991, 4(7), 724 - 31
Safety and immunogenicity of multiple conventional immunizations administered during early HIV infection; Rhoads JL et al.; 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.

Zh Nevropatol Psikhiatr Im S S Korsakova, 1991, 91(12), 50 - 4
{Characteristics of the cerebrospinal fluid in the evaluation of possible mechanism of brain lesions in suppurative meningitis of meningococcal and pneumococcal etiologies}; Roslyi IM; The enzymological parameters of the CSF were studied and compared in patients with purulent meningococcal and pneumococcal meningitis in addition to the detection of the CSF levels characteristic of the dead patients . The level of enzymorachia was shown to depend on the degree of leukocyte degradation as well as on the lipid peroxidation intensity in the CSF . These data were obtained on the basis of measuring the content of cerebral and leukocytic enzymes in the acute period and on days 7-10 of the disease . It has been also noted that evident signs of meningoencephalitis are detectable even on days 7-10 according to the enzymic levels . As compared to pneumococcal infection, the lysis of leukocytes in patients with meningococcal infection turned out more noticeable, being maximal in the dead.

Zh Nevropatol Psikhiatr Im S S Korsakova, 1991, 91(2), 50 - 2
{The role of circulating immune complexes and the status of argyrophilic membranes of the vascular walls in the development of brain edema in patients with meningococcal meningoencephalitis}; Gebesh VV et al.; Based on clinical and immunological examinations of 60 patients with MME and 30 normal persons, the dynamics of the blood CIC content was studied depending on the time and gravity of the disease . The discovered changes in argyrophilic membranes of the vascular walls are determined to a considerable measure by the pathogenic action of CIC on microvessels, which entails the derangement of blood-brain barrier function and contributes to the development of acute purulent meningitis.

J Immunol Methods, 1990 Dec 31, 135(1-2), 101 - 9
Preparation of proteosome-based vaccines . Correlation of immunogenicity with physical characteristics; Ruegg CL et al.; In order to facilitate the use of proteosome-based vaccines, we have identified and analyzed the parameters that affect their immunogenicity . As a model system we used synthetic peptides (LCF6) containing sequences from the immunodominant (NANP)n tandem repeat region of the P . falciparum circumsporozoite protein, hydrophobically complexed to multimeric protein preparations (proteosomes) of meningococcal outer membrane proteins (OMP), since we have previously shown that high levels of anti-(NANP)n IgG can be elicited in mice by use of this novel adjuvant system (Lowell et al., 1988a) . We have now examined these preparations by velocity sedimentation and measured their ability to elicit an IgG response in mice . Velocity sedimentation of freshly mixed OMP and LCF6, without dialysis, produced a limited number of small complexes, whereas dialysis of the mixture for 4 d yielded heterogeneously sized complexes that became more homogeneous when the dialysis was carried out for 7 or 10 days . The most homogeneous of these peptide-proteosome complexes (those dialyzed for 10 days) induced substantial levels of anti-(NANP)n IgG in mice, and shorter periods of dialysis resulted in vaccines that induced proportionately lower titers . Analysis of a series of preparations with varying LCF6: OMP ratios (w/w) showed that the degree of peptide substitution of the proteosomes was inversely proportional to the rate of sedimentation of the complexes and that there exists an optimal degree of lipopeptide complexing to the proteosomes . Our results suggest that the parameters affecting the immunogenicity of the peptide-proteosome complexes are: (i) hapten density, and (ii) size of the complex . Furthermore, sedimentation analysis of peptide-proteosome immunogens may serve as a rapidly performed assay of immunogenic potency.

Ugeskr Laeger . 1990 Dec 17;152(51):3872.
{Atypical meningococcal disease diagnosed with meningococcal antibody test}; Weis N et al.; The case histories of three patients with atypical meningococcal disease in whom the diagnosis was established by means of a meningococcal antibody test (MAT) are presented . One patient had clinically atypical, but bacteriologically verified meningococcal disease; the other two patients were primarily suspected of having viral infections . The usefulness of investigation for meningococcal antibodies in serum from patients with assumed meningococcal disease or with fever of unknown origin is stressed.

Epidemiol Infect, 1990 Dec, 105(3), 579 - 83
Vaccination campaign against meningococcal disease in army recruits in Italy; Stroffolini T; A high attack rate (17.3/100,000) of meningococcal disease in army recruits in Italy, with 95% of the cases due to serogroup C, constituted the motivating factors to make bivalent serogroup A + C meningococcal vaccination compulsory by law for army recruits starting January 1987 . Because the vaccine was given only to the new recruits entering the army, full coverage was not achieved until January 1988 . Nearly 900,000 subjects (300,000 yearly) were vaccinated between January 1987 and December 1989 . There were no reports of any untoward reactions to the vaccine . Of the 300,000 recruits in service each year, 52, 21, 15, 5 and 4 cases of the disease occurred in 1985, 1986, 1987, 1988 and 1989, respectively (P less than 0.001) . Of the 24 cases occurring since the start of the vaccination, only two (due to serogroup C) were attributable to vaccine failure . The remaining cases were in unvaccinated recruits (15 cases) or were due to serogroups other than A or C (7 cases) . The cumulative incidence of meningococcal serogroup C in the 600,000 vaccinated recruits during the period 1988-89 was 0.2/100,000 (1 case amongst 600,000 recruits), while the corresponding figure in the 600,000 unvaccinated recruits during the period 1985-6 was 11.3/100,000 (68 cases amongst 600,000 recruits) (P less than 0.001) . The protective efficacy of the vaccine in 1987 was 91.2% (12 cases of meningococcal serogroup A and C disease from an average of 150,000 unvaccinated recruits observed for 1 year, and 1 case from the corresponding average of 150,000 vaccinated ones) . In 1988 and in 1989 this figure could not be calculated because all recruits were vaccinated.(ABSTRACT TRUNCATED AT 250 WORDS)

Zh Mikrobiol Epidemiol Immunobiol, 1990 Dec, (12), 50 - 5
{The reactogenicity and antigenic activity of a meningococcal group B vaccine made from a natural complex of the specific polysaccharide and outer membrane proteins}; Basnak'ian IA et al.; Group B meningococcal vaccine consisting of the natural complex of specific polysaccharide and outer membrane protein (OMP) has been shown to be moderately reactogenic, safe with respect to the effect of undermining tolerance to human brain tissue antigens and to produce no allergization of humans . The vaccine under study possesses antigenic activity: (a) immunization with this vaccine ensures the fourfold rise of the level of antibodies to the group-specific polysaccharide of group B meningococcus in about 80% of persons with the initially low level of antibodies, this percentage being retained during the whole period of observation, i . e . 85 days; (b) the vaccine enhances the level of antibodies to meningococcal OMP, determined in the enzyme immunoassay and the passive hemagglutination test; (c) these data are indicative of the expediency of immunizing the risk groups of persons with the initially low level of antibodies.

J Commun Dis, 1990 Dec, 22(4), 264 - 8
Nasopharyngeal carriage of Neisseria meningitidis in general population and meningococcal disease; Ichhpujani RL et al.; Nasopharyngeal carriage of Neisseria meningitidis was determined in the normal healthy population in Delhi at monthly intervals for a period of 2 years from January, 1986 to December, 1987 . Of a total of 6513 individuals screened only 107 (1.64 per cent) were found to carry Neisseria meningitidis serogroup A . There was no age and sex difference in carriage . During the same period, data of laboratory confirmed cases of meningitis due to N . meningitidis serogroup A was obtained from 6 hospitals of Delhi which acted as sentinel centres . Of the total 11,870 pyogenic C.S.F . samples processed, only 557 (4.69 per cent) were due to N . meningitidis serogroup A . There was no correlation observed between the nasopharyngeal meningococcal carriage in the healthy population with the disease prevalence . There was no seasonal variation in nasopharyngeal carriage though upsurge in the number of meningococcal meningitis cases was noticed from January to April.

APMIS, 1990 Dec, 98(12), 1061 - 9
IgG subclass antibodies to serogroup B meningococcal outer membrane antigens following infection and vaccination; Sjursen H et al.; IgG and IgG subclass antibodies to the outer membrane antigens from Neisseria meningitidis (serogroup B, serotype 15:P1.16) were quantitated by an enzyme-linked immunosorbent assay (ELISA) in sera from 40 patients with group B:15:P1.16 meningococcal disease and 24 volunteers immunized with a serotype 15:P1.16 outer membrane vesicle vaccine . A second injection was given 6 weeks after the first immunization . Patient sera obtained two and six weeks after onset of the disease had significantly higher levels of total IgG, IgG1, IgG2, and IgG3 antibodies to the outer membrane antigens than acute sera, convalescent sera from patients with systemic non-meningococcal bacterial infections and sera from healthy controls . The levels of total IgG and IgG1 remained high one and three years later . Sera from the vaccinees showed high levels of total IgG and IgG1 6, 12 and 26 weeks after the first immunization and high levels of IgG3 6 weeks after the second immunization . No increase of IgG2 or IgG4 levels was observed in the postimmunization sera . Immunoblotting of three convalescent sera demonstrated individual patterns of IgG subclass binding to various outer membrane antigens with most distinct binding of IgG1 and IgG3 antibodies to the class I protein, the H.8 lipoprotein and the lipopolysaccharide . Since IgG1 and IgG3 are the most effective antibodies for complement activation and phagocytosis, group B meningococcal disease and immunization with the serotype 15:P1.16 outer membrane vesicle vaccine stimulate production of those IgG subclasses which have the strongest opsonic and bactericidal activity.

Zhonghua Liu Xing Bing Xue Za Zhi, 1990 Dec, 11(6), 321 - 4
{Surveillance of epidemiological features for epidemic cerebrospinal meningitis in China during 1980s}; Hu X; This paper reports the results of surveillance of epidemiological features for epidemic cerebrospinal meningitis in China during 1980s . Although the incidence of this disease in China in 1984 were up about 50% comparing with in 1983, its morbidities of recent years had been continued to decrease . The patients were distributed rather far apart from one another and the feature of cyclic incidence peak for epidemic cerebrospinal meningitis in 1980s was not obvious as former . However, the possibility which this disease will present prevalence still exists . Because the morbidity would begin to rise again after it decreased to the lowest level . At present, such rising signs have been appeared in some provinces . In addition, Neisseria meningitidis group B isolated from the cases tended to increase . The proportion of cases of young children was increased obviously in comparison with elder children or adults . This status makes the prevention of this disease by using meningococcal polysaccharide vaccine group A some difficulty . The authors also investigated and analysed the effect of normal throat flora of healthy people and other acute respiratory infectious diseases on the epidemic cerebrospinal meningitis.

Infect Immun, 1990 Dec, 58(12), 3929 - 33
Distribution of a protein antigenically related to the major anaerobically induced gonococcal outer membrane protein among other Neisseria species; Hoehn GT et al.; The Pan 1 protein of Neisseria gonorrhoeae is a novel 54-kDa outer membrane protein expressed only when gonococci are grown in the absence of oxygen . It is a major antigen recognized by sera from patients with gonococcal infection . We raised mouse monospecific polyclonal antiserum to gel-purified Pan 1 from gonococcal strain F62 . The antiserum was broadly cross-reactive among gonococcal strains; all strains tested reacted in immunoblot analysis proportionate to the amount of Pan 1 visible in silver-stained sodium dodecyl sulfate (SDS)-polyacrylamide gels . In immunoblot experiments, N . lactamica and N . cinerea reacted very strongly to the anti-Pan 1 antiserum, whereas N . sicca, N . flava, and N . mucosa did not react at all . The other commensals tested, N . subflava and N . perflava, exhibited only a minor reaction . These results correlated with the apparent amount of Pan 1 seen on SDS-polyacrylamide gels of outer membranes . SDS-polyacrylamide gel analysis of six meningococcal strains revealed no visible anaerobically induced outer membrane proteins, and the subsequent immunoblots showed only slight or no reaction to the anti-Pan 1 antibody . In the four meningococcal strains that did react slightly with the antiserum, a Pan 1-like protein was seen only in anaerobically grown cells . Thus, meningococci did not express Pan 1 at levels comparable to that found in gonococci; however, when Pan 1 was expressed in meningococcal strains, it was oxygen regulated . This is the first example of a protein found in the gonococcal outer membrane that, under identical growth conditions, is not expressed at similar levels in the meningococcus.

NIPH Ann, 1990 Dec, 13(2), 45 - 60
Some arguments on early hospital admission and treatment of suspected meningococcal disease cases; Gedde-Dahl TW et al.; Arguments are presented which indicate or show that: (1) Diagnostic precision and severity level of systemic meningococcal disease (MCd) both seem to rise exponentially with the developmental stage of the disease at referral . Lowering of the clinical admission threshold improves early coverage of vaguely suspected cases and should probably be implemented in Norway . (2) Fear that cell wall active bactericidal antibiotics could trigger important endotoxin release may cause unnecessary treatment delays . (3) Although risk of death due to meningococcal septicemia is the main indication for early treatment of MCd, the risk of sequelae may also become a major cause for very early treatment of MCd . (4) Treatment delays for MCd cases could have been substantially reduced by implementing reasonable guidelines . (5) In the relations between the public and the health service both organizational and psychological factors are operating . (6) Increased awareness among professionals and lay people of some key symptoms and signs may facilitate earlier diagnosis of MCd . (7) Earlier treatment of meningococcal disease is now feasible and does seldom preclude the possibility of etiological diagnosis . (8) More relevant studies and information on the early phases and rapid management of MCd are highly desirable . Rapid diagnosis and treatment of MCd are very important to reduce death, sequelae and community costs and should be more advocated in training of health personnel and in public information.

Chem Pharm Bull (Tokyo), 1990 Dec, 38(12), 3347 - 54
Neuraminic acid and related compounds . V . Syntheses of biologically active sialosyl-glycerol derivatives and galactosyl-glycerol derivative; Shimizu C et al.; New 1-acyl-sialosyl-glycerol derivatives (1a--d alpha, 1a--d beta, 2 alpha, 2 beta, which mimic the structure of the capsular polysaccharide of group C meningococcal were synthesized by the use of a chiral glycerol derivative, and were found to have phospholipases A2 and C inhibitory activities . Furthermore, synthesis of 2-palmitoyl-sialosyl-glycerol derivative (4 alpha, 4 beta, 5 alpha, 5 beta), galactosyl-glycerol derivative (6), and sialosyl-galactosyl-glycerol derivative (7) were carried out to examine the difference between these activities . Among these sialosyl derivatives, 3-palmitoyl-sialosyl-glycerol derivatives (1--3 alpha, 1--3 beta) demonstrated the most potent inhibitory activities.

Acta Paediatr Scand, 1990 Dec, 79(12), 1255 - 8
Sonographic diagnosis of adrenal hemorrhage in patients with fulminant meningococcal septicemia; Enriquez G et al.; We report two patients with fulminant meningococcal septicemia, in whom massive bilateral adrenal hemorrhages were diagnosed by ultrasound . Low plasma cortisol levels were found in one patient who eventually died . The other patient survived and has remained asymptomatic for the last three years . His adrenal function is normal . We suggest that routine ultrasound examination should be performed in patients with meningococcal sepsis and shock in order to clarify the prevalence of a renal hemorrhage . Determination of plasma cortisol levels in patients with adrenal hemorrhage, would allow identification of those with adrenal insufficiency who may benefit from steroid replacement.

Med J Aust, 1990 Nov 5, 153(9), 556 - 9
Chronic meningococcal disease; Jennens ID et al.; Chronic meningococcal septicaemia is an unusual and infrequently recognised presentation of disease caused by Neisseria meningitidis . Clinical features are immunologically mediated and include fever, rash and arthritis, which may mimic cutaneous vasculitis or reactive gonococcal arthritis . Diagnosis is difficult to confirm as blood cultures commonly do not grow the organism despite weeks of symptoms . Culture of the organism from the nasopharynx may provide supportive evidence for diagnosis . Chronic meningococcaemia should be considered in the differential diagnosis of a cutaneous vasculitis . In the clinical setting of an undiagnosed fever with vasculitic rash and joint symptoms an empirical trial of intravenously administered penicillin should be considered before steroid therapy as a rapid response may simplify the diagnostic dilemma.

Clin Neuropathol, 1990 Nov-Dec, 9(6), 290 - 4
Malignant pigmented spinal nerve root schwannoma metastasizing in the brain and viscera; Cras P et al.; A 46-year-old woman suffered a meningococcal meningitis followed by a rapidly progressive lumbosacral pluriradicular syndrome . Myelography showed multiple nodules on the lumbar radices . A biopsy showed tissue with numerous Verocay-like bodies, spindle shaped and lymphocytoid cells which was diagnosed as schwannoma . There was a small group of polygonal cells with somewhat irregular and hyperchromatic nuclei . Postoperatively, she developed intracranial hypertension and died . CT scan and MRI revealed multiple occipital lesions consistent with metastases . At autopsy the cauda equina showed multiple nodular lesions with morphology comparable to the biopsy . However, pigment producing cells were also present . There were metastases with distinct morphological features in the brain, myocardium, thyroid gland and pancreas . Some consisted of pigmented, large, pleomorphic cells, others of non-pigmented, spindle-shaped and less pleomorphic cells . In this case, the diagnosis of metastasizing pigmented schwannoma is the most plausible hypothesis.

Rev Infect Dis, 1990 Nov-Dec, 12(6), 973 - 92
Severity of meningococcal disease: assessment by factors and scores and implications for patient management; Gedde-Dahl TW et al.; Results from our own and other published series of cases of meningococcal disease were used to study prognostic factors and to compose scores for assessment of severity of disease on admission to the hospital . The difference in risk for fatality was designated the factor fatality difference (FFD); the FFD was determined by subtracting the percent fatality for factor-negative patients from the percent fatality for factor-positive patients . FFD was useful for selection of good indicators of severity of disease . Blood pH of less than 7.35 was the best single factor; low platelet count came next, followed by low blood pressure, cyanosis, ecchymosis, and low blood leukocyte count . New scores were constructed based on multiple regression analyses . Several older and new scores seemed to be comparable . By combining age-adjusted systolic blood pressure (less than 100 mm Hg), cyanosis, ecchymosis, diarrhea before or at admission, cold extremities, absence of nuchal or back rigidity, and rectal temperature of greater than or equal to 40 degrees C, a simple bedside percentage score, the MenOPP bedside clinical score (MOC), was devised . Cross-evaluations on test materials generally confirmed the choice of score . The simplicity of this score made it more clinically suitable than laboratory or mixed laboratory and bedside scores.

Arch Intern Med, 1990 Nov, 150(11), 2395 - 9
Recurrent meningitis in a patient with congenital deficiency of the C9 component of complement . First case of C9 deficiency in Europe; Zoppi M et al.; We describe the first cases, to our knowledge, of C9 deficiency in Europe that were detected in a Swiss family, of which two members--one with a complete deficiency and the other with approximately half-normal C9 levels--experienced bacterial meningitis . The index patient, a 56-year-old white man with a history of purulent meningitis at the age of 23 years, presented with an acute meningococcal meningitis . No impairment of cellular immunity or immunoglobulin deficiency could be found . Complement assays showed a complete deficiency of the C9 component, while the other individual component levels were normal and the hemolytic activity (measured using the CH50 assay) was only slightly reduced . A family study revealed complete C9 deficiency in the patient's healthy brother and half-normal C9 concentrations in his sister, his son (who also had experienced an episode of bacterial meningitis), and his niece, consistent with an inherited C9 deficiency . This first case of recurrent meningitis in a white patient with complete C9 deficiency suggests that this complement defect may also be a risk factor for bacterial, especially neisserial, infections.

Offentl Gesundheitswes, 1990 Nov, 52(11), 648 - 52
{Epidemiologic studies of various forms of meningitis based on public health reports in West Berlin from 1981 to 1985}; Brettschneider V et al.; In the Federal Republic of Germany, four types of meningitis must be reported since 1980 instead of the previous two categories (i.e . meningococcal disease and other forms of meningitis) . Consequently, various forms of purulent meningitis can be differentiated from viral meningitis . A retrospective study, considering the population of West Berlin, carried out between the years 1981 and 1985, shows the influence of age, nationality and living areas on morbidity and mortality rate . A critical evaluation was undertaken, considering possible changes in management efficiency of public health authorities since the introduction of the new reporting system . Population at high risk, predisposed to develop meningococcal meningitis, are mainly Turkish children living in areas of high population density and poor social structure . The activities of the public health administration seem inadequate . The reported meningitis cases were partly filed wrongly and thus were transmitted wrongly to the Federal Office of Statistics (Statistisches Bundesamt) . No substantial scientific epidemiological analysis was performed . The most frequent reaction of public health authorities was disinfection of apartments, day-care centres and schools, as done for example in 67% of the reported meningococcal meningitis cases, although it is well known that there is no reason for room disinfection in droplet-transmitted infection of the nasopharyngeal mucosa . As shown by our results, the differentiation of the reporting system in use since 1980 did not prove advantageous considering the health policy and epidemiological research of prevention in our study area . Disinfection measures are obsolete.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Nov, (11), 63 - 9
{The diagnostic value of a meningococcal-B erythrocyte diagnostic agent based on the group-specific polysaccharide}; Martynov IuV et al.; In this work the diagnostic value of group B meningococcal erythrocyte diagnosticum was determined . 585 blood serum samples taken from adult donors were studied: 220 samples from practically healthy persons and 365 samples from 144 patients with meningococcal infection and purulent bacterial meningitis of nonmeningococcal etiology . Group B meningococcal erythrocyte diagnosticum was found to possess serological activity and to reveal the growth of specific antibodies in the sera of patients with meningococcal infection, serologically confirmed by the isolation of group B meningococcal culture, in 100% of cases on weeks 2-3 of the disease . Diagnostic characteristics--specificity and sensitivity--for group B erythrocyte diagnosticum were, respectively, 90.2% and 63.5% . The study revealed that antibodies to several group-specific meningococcal polysaccharides in blood sera can be simultaneously determined in the passive hemagglutination test with a set of erythrocyte diagnostica, which should be taken into consideration in the clinical interpretation of serological results.

Antimicrob Agents Chemother, 1990 Nov, 34(11), 2269 - 72
Neisseria lactamica and Neisseria polysaccharea as possible sources of meningococcal beta-lactam resistance by genetic transformation; Saez-Nieto JA et al.; We studied the susceptibilities of relatively penicillin G-resistant and -susceptible strains of Neisseria meningitidis, as well as Neisseria lactamica and Neisseria polysaccharea, to penicillin, ampicillin, and several cephalosporins . The MICs of penicillin, ampicillin, cephalothin, and cefuroxime for moderately resistant meningococci have increased two- to sixfold in relation to MICs for susceptible strains . For these strains of meningococci, N . lactamica, and N . polysaccharea, penicillin, ampicillin, cephalothin, and cefuroxime MICs for 50 and 90% of strains were similar . By genetic transformation of a penicillin-susceptible strain of N . meningitidis to low-level penicillin resistance with DNA from penicillin-resistant strains of N . meningitidis, N . lactamica, N . polysaccharea, and N . gonorrhoeae, isogenic strains with the same pattern of resistance to beta-lactams were obtained, suggesting that these commensal Neisseria spp . could be the source of meningococcal resistance genes.

Br J Clin Pract, 1990 Nov, 44(11), 508 - 9
Meningococcal septicaemia presenting as erythema multiforme; Raman GV; A 48-year-old woman presented with a three-week history of recurrent, generalised rash, flitting joint pains, frontal headache and shivering attacks . On admission she was pyrexial and exhibited a symmetrical generalised maculopapular rash with a few target lesions . The rash faded within the first 24 hours, but over the following week it recurred at intervals of 48 hours and was accompanied by fever and headache . She was started on a short course of steroids, which did not alter her symptoms or signs . Eight days after admission, the patient underwent a lumbar puncture, despite the absence of definite signs of meningeal irritation . The cerebrospinal fluid (CSF) was turbid and diagnostic of bacterial meningitis . Cultures of blood and CSF taken on the day of admission both grew Neisseria meningitidis . The patient was successfully treated; symptoms were completely resolved.

Br J Clin Pract, 1990 Nov, 44(11), 505 - 6
Acute meningococcal infection--a case of monoarthrosis; Walsh HP et al.; A case of septic arthritis in the right knee of a six-month-old girl is described . Neisseria meningitidis was grown from the purulent exudate from the knee joint . No other manifestations of meningococcal disease were observed . Complete recovery followed aspiration and treatment with benzyl penicillin.

Zentralbl Bakteriol, 1990 Nov, 274(2), 135 - 54
Pathogenic neisseriae--a model of bacterial virulence and genetic flexibility; Meyer TF; The outcome of the early stages of a neisserial infection is determined by receptor-mediated events that culminate in the attachment and invasion of human mucosal tissues . The factors participating in this process, including pili, opacity proteins (Opa), and perhaps lipopolysaccharide (LPS), are subject to complex genetic controls that allow these factors to be produced in multiple forms . Antigenic variation allows the pathogenic Neisseriae to evade the human immune response, and facilitates their interaction with a variety of different cells and tissues of the human host . One of the major genetic mechanisms causing antigenic variation is transformation, which allows virulence genes to be exchanged and recombined between independent Neisseria strains within multiply infected individuals . A number of other factors, such as IgA protease, alpha-factor, and the meningococcal capsule are also implicated in pathogenesis and render the pathogenic Neisseriae an excellent model for the investigation of bacterial virulence.

Biull Eksp Biol Med, 1990 Nov, 110(11), 510 - 3
{The role of fibronectin in the pathogenesis of meningococcal infection}; Alekseev AB et al.; We have characterized an interaction of 20 strains of Neisseria meningitidis serogroups A, B, C, 29E, W-135 and Z with immobilized fibronectin of human plasma . The adhesion of meningococci to fibronectin was determined by the extent of piliated cells and did not depend on the meningococcal serogroup . Binding of non-piliated or weakly piliated strains (2-5% of piliated cells in the stock) was sufficiently greater than those piliated (8-10%), where the adhesion to fibronectin was not at all observed . The examination of two well-piliated strains showed that the loss of pili resulted in the increase of bacterial adhesion to fibronectin . Constants of association and dissociation of piliated and non-piliated strains to fibronectin were calculated . The role of meningococci-fibronectin interaction in the pathogenesis of meningococcal infection is discussed.

Klin Wochenschr, 1990 Oct 3, 68(19), 976 - 80
Successful therapy of meningococcal sepsis in acute disseminated lupus erythematosus with plasmapheresis, immunosuppression, and antibiotics; Dobos GJ et al.; A 17-year-old female with a 5-year history of disseminated lupus erythematosus has remained without immunosuppressive therapy for the last 3 years . She was admitted to the hospital for acute abdominal pain, generalized edema, and rapidly developing dyspnea and somnolence . Although all symptoms were consistent with active SLE, septicemia was suspected because of leukocytosis (20,000/microliters), greatly elevated C-reactive protein (45 mg/dl), and normal complement values (C3 0.74 g/l, C4 0.21 g/l) . Directly after bacterial blood cultures were prepared, a combined treatment was instituted consisting of plasmapheresis (3 x 2.1 l against fresh frozen plasma), antibiotics, prednisolone, and cyclophosphamide following the last plasmapheresis . Within three days cerebral function returned to normal, edema improved, and CRP fell to 0.5 mg/dl . The blood cultures and pericardial effusion displayed meningococcal colonies.

J Endocrinol Invest, 1990 Oct, 13(9), 743 - 7
Hypoglycemia, hormones and cytokines in fatal meningococcal septicemia; Romijn JA et al.; A unique case report with sequential measurements of the plasma concentrations of glucoregulatory hormones, interleukin-6 and tumor necrosis factor during development of hypoglycemia in fatal meningococcemia is presented . Hormonal explanations for hypoglycemia like hyperinsulinemia or defective hypoglycemic counter-regulation were excluded . Plasma concentrations of interleukin-6 and tumor necrosis factor were skyhigh . The putative relation between cytokines and hypoglycemia in sepsis is discussed.

APMIS, 1990 Oct, 98(10), 861 - 74
Inherited complement deficiency states: implications for immunity and immunological disease; Sjoholm AG; The study of complement deficiency states and their influence on immune function has generated new insights and still provides a challenge to continued investigation . The association of classical pathway deficiencies (C1, C4, C2 or C3) with immunological diseases such as SLE and glomerulonephritis has contributed to current knowledge concerning complement-dependent immune complex handling and elimination . Susceptibility to systemic infection with encapsulated bacteria is encountered in most forms of inherited complement deficiency . Recurrent neisserial infection is the only clinical manifestation clearly associated with defects of the membranolytic sequence C5-C9, while deficiency of properdin, a component of the alternative activation pathway, appears to predispose to nonrecurrent meningococcal disease . Inherited complement deficiency is rare, but the perspective is widened by the more common occurence of acquired defects in immunological diseases, and the apparent requirement for efficient complement recruitment in host defense . Another aspect is the possibility that complement deficiency might alleviate or prevent inflammatory symptoms . Notably, complement deficiency has not been reported in classical rheumatoid arthritis . Considerations of this kind would be refuted or modified by findings of complement deficiency in single patients.

DICP, 1990 Oct, 24(10), 947 - 8
Fixed drug eruption following rifampin treatment; Mimouni A et al.; A case of fixed drug eruption (FDE) associated with ingestion of rifampin in a young physician is reported . The drug was prophylactically administered because of a previous close contact with a meningococcemic patient . The eruption consisted of two solitary painless purplish lesions located over the extensor surface of the left forearm, characteristic of FDE, except for the absence of residual hyperpigmentation . It is suggested that slight lesions of FDE could be unnoticed or misdiagnosed, thus raising the possibility that such skin reactions to rifampin are more frequent than is reflected in the literature.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Oct, (10), 29 - 32
{The effect of gangliosides on the adhesive interaction of Neisseria meningitidis with human cells}; Rumiantsev SN et al.; The influence of a number of gangliosides and sialic acid on the adhesive interaction of meningococci and human cells have been studied . Sialic acid has been found to produce no influence on adhesion, and the preliminary treatment of meningococci with gangliosides or their preparations suppresses the capacity of meningococci for attachment to epithelial cells and erythrocytes . At the same time the degree of the inhibition of adhesion depends on the kind and concentration of gangliosides . On the contrary, after the treatment of target cells with gangliosides (1.25 micrograms/ml) the adhesion indices of meningococci with respect to these cells increase 5- to 8-fold . These data are indicative of the participation of gangliosides in the adhesive interaction of meningococci and human cells.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Oct, (10), 118 - 21
{The protective activity of polyclonal and monoclonal antibodies to the lipopolysaccharide of Neisseria meningitidis serogroup A in in vivo experiments}; Del'vig AA et al.; The protective activity of the sera of mice immunized with the preparations of native and detoxified N . meningitidis lipopolysaccharide (LPS), group A, as well as with monoclonal antibodies to N . meningitidis antigens, groups A and B, was studied on the mucin model of meningococcal infection . The study showed that the maximum level of anti-LPS antibodies in mice was observed on day 7 after the injection of LPS . Immune sera obtained from mice were capable of protecting the animals from fetal meningococcemia induced by N . meningitidis strains of homologous and heterologous groups . As shown by the results of this study, the alkaline treatment of N . meningitidis native LPS did not decrease the protective properties of antibodies . The monoclonal antibodies under study were found to possess high preventive activity in mice challenged with N . meningitidis, groups A and B . Anti-LPS monoclonal antibodies showed greater protective activity than antipolysaccharide monoclonal antibodies.

J Infect Dis, 1990 Oct, 162(4), 867 - 74
Clones of serogroup B Neisseria meningitidis causing systemic disease in The Netherlands, 1958-1986; Caugant DA et al.; Serogroup B isolates of Neisseria meningitidis recovered from 278 patients with systemic disease in the Netherlands between 1958 and 1986 were analyzed with respect to serotype and multilocus enzyme genotype . Of the isolates, 28% were serotype 2b and 53% were neither serotypeable nor serosubtypeable . There were 145 distinct multilocus genotypes (electrophoretic types, ETs), with up to 31 isolates belonging to the same ET . Temporal changes in the genotypic composition of meningococcal populations in the Netherlands were demonstrated by the recent occurrence of disease caused by three clone lineages, I, III, and VI, that were not found before 1975 . The epidemic of 1966-1967 and the hyperendemic wave of 1972 were caused, in large part, by two closely related but distinct clones of serotype 2b isolates, ET-11 and ET-17, respectively . Deviations in male-to-female ratio and age distribution of patients were observed for disease caused by isolates of individual clone lineages.

J Assoc Physicians India, 1990 Oct, 38(10), 779 - 80
Pyogenic meningitis; Mital HS et al.; Fifty cases with pyogenic meningitis, aged 15 to 72 years, with a male:female ratio of 5:1, were studied . The majority of cases (70%) were in the 15 to 25 years age group . The organisms detected in the 29 culture-positive cases included S aureus (12), pneumococci (9) and meningococci (8) . Thirteen patients died; the poor prognostic factors included old age, the presence of coma or shock, CSF sugar below 10 mg/dl or protein above 750 mg/dl and the presence of gram negative organisms in the CSF.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Oct, (10), 84 - 9
{A comparative study of the immunogenicity of 2 group-B meningococcal vaccines in monkeys}; Krasnoproshina LI et al.; The comparative study of two group B meningococcal vaccines manufactured in the USSR and in Cuba was made . The vaccine manufactured in the USSR contained the noncovalent compound of group B Neisseria meningitidis polysaccharide and outer membrane protein, and the Cuban vaccine contained group B N . meningitidis outer membrane proteins and group C N . meningitidis polysaccharide . The data obtained in this study indicated that both vaccines possessed immunological potency evaluated according to their capacity to stimulate the formation of bactericidal antibodies, whose level was found to increase eightfold after the immunization of monkeys in two injections . Besides, group B meningococcal vaccines did not induce the suppression of nonspecific protective activity characteristics of the body and did not stimulate the formation of autoantibodies to brain and liver tissues, which was indicative of the safety of these vaccines.

JAMA, 1990 Sep 12, 264(10), 1271 - 5
Respiratory viruses and mycoplasma as cofactors for epidemic group A meningococcal meningitis; Moore PS et al.; To investigate the role of coincident respiratory viral and mycoplasmal agents in the pathogenesis of meningococcal meningitis, we performed a matched case-control study of 62 patients with group A meningococcal meningitis during an epidemic in Chad . Case patients were more likely than controls to have nasal colonization or infection with respiratory viruses and Mycoplasma species (matched odds ratio, 23; 95% confidence interval, 3.1 to 170) . Respiratory pathogens were found more commonly in older patients with meningitis (odds ratios were 2.9 for children under age 5 years and 46.5 in those over age 15 years), consistent with the increasing risk of meningitis with age during epidemics . In controls, the presence of respiratory pathogens increased the risk of upper-respiratory-tract symptoms but did not significantly increase meningococcal carriage.

Clin Exp Immunol, 1990 Sep, 81(3), 423 - 7
Prevalence of hereditary properdin, C7 and C8 deficiencies in patients with meningococcal infections; Schlesinger M et al.; High incidence of hereditary complement (C) deficiencies was found among 101 patients who had a meningococcal disease . This study revealed 11 non-related patients with complete C deficiency: five deficient in C7, three in C8, two in properdin and one in C2 . Additional C-deficient individuals, most of them with no history of severe bacterial infections, were detected in family studies . The C8-deficient patients were found to have a selective deficiency of the C8-beta subunit and a reduced expression of the alpha/gamma subunit . Only a few families with properdin deficiency have been described so far . However, it is likely that frequent analysis of the activity of the alternative C pathway in survivors of severe bacterial infections will disclose numerous properdin-deficient patients . All our C7-, C8- and properdin-deficient patients are Sephardic Jews whose families originated from Morocco, Yemen (C7 and C8 deficient) or Tunisia (properdin deficient) . This and other findings indicate that the type of complement abnormality found in association with meningococcal infections varies with the ethnic origin of the patient.

Rev Infect Dis, 1990 Sep-Oct, 12(5), 838 - 47
Primary meningococcal conjunctivitis: report of 21 patients and review; Barquet N et al.; Neisseria meningitidis is an uncommon cause of acute bacterial conjunctivitis . Twenty-one cases of primary meningococcal conjunctivitis (PMC) are reported herein and 63 cases published in the literature since 1899 are reviewed . In the 84 cases of PMC available for analysis, the male-to-female ratio was 1.76:1; nine of the patients were neonates, 55 were children, and 20 were adults . Conjunctivitis was unilateral in 66.3% of the patients . Gram stain of conjunctival exudate disclosed gram-negative diplococci in all cases in which it was done . Culture of the conjunctival exudate yielded N . meningitidis in all cases, and 44% of the isolated meningococci belonged to serogroup B . Ocular complications, which occurred in 15.5% of the patients, most frequently were corneal ulcers . Systemic meningococcal disease developed in 17.8% of the patients; the overall mortality was 13.3% for patients with PMC complicated by systemic disease . Development of systemic disease was significantly more frequent in patients receiving only topical therapy than in those treated with systemic therapy (31.71% vs . 2.38%; P = .001) . Gram-negative diplococci observed in conjunctival exudate are an indication for systemic antibiotic therapy because of the risk of systemic complications associated with the use of topical therapy alone . When properly treated, patients with PMC have a favorable prognosis.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Sep, (9), 40 - 3
{Detection of individuals within a group of risk for meningococcal infection morbidity in organized collectives}; Efimov EI et al.; The survey of 2,500 persons in different educational organized groups has been carried out by the method based on the study of changes occurring in the standard population of group A meningococci due to its interaction with the surviving culture of human leukocytes . The heterogeneity of humans with regard to the individual antimeningococcal activity of their blood irrespective of their levels of humoral immunity and complement activity has been revealed . The survey has shown the possibility of detecting the groups of risk among the members of organized groups having, according to our data, a significantly higher level of morbidity in generalized meningococcal infection and meningococcal carriership (including epidemiologically important groups A, B and C).

Infect Immun, 1990 Sep, 58(9), 2875 - 81
Expression of Neisseria meningitidis iron-regulated outer membrane proteins, including a 70-kilodalton transferrin receptor, and their potential for use as vaccines; Banerjee-Bhatnagar N et al.; The iron-regulated proteins (IRPs) of five group B meningococcal strains expressing class 2 outer membrane proteins were compared with those of five strains expressing class 3 proteins . Three to four high-molecular-weight IRPs were expressed by each strain, but their molecular sizes varied between strains and were not related to class 2 or 3 protein expression . Transferrin and hemoglobin could be used as a sole iron source . By using anti-human transferrin antibodies, it was shown that meningococcal cells and purified outer membranes bound transferrin . Growth under conditions of iron limitation caused a several-fold increase in the amount of transferrin bound to the cell surface . The transferrin-binding protein was detergent solubilized from outer membranes and partially purified . The isolated protein bound human transferrin and had an apparent molecular mass of 70 kilodaltons . To evaluate the potential of vaccines containing IRPs, we prepared outer membrane vaccines from strains M986-NCV-1 (M986) (--:2a: P1.2) and 44/76-M25 (44/76) (--:15:P1.15) grown to fully express their IRPs . Both vaccines induced significant anti-IRP antibodies as measured by enzyme immunoassay and by Western immunoblot with both M986 and 44/76 outer membranes . By Western blot analysis, the M986 vaccine induced antibodies to two different IRPs, one of which was shared with 44/76 . Since the IRPs are major in vivo-expressed outer membrane proteins and are required for survival in vivo, these proteins should be evaluated for their usefulness in a group B meningococcal vaccine.

Infect Immun, 1990 Sep, 58(9), 3036 - 41
Monoclonal antibodies against the 70-kilodalton iron-regulated protein of Neisseria meningitidis are bactericidal and strain specific; Pettersson A et al.; When grown under iron limitation, Neisseria meningitidis expresses a number of outer membrane proteins (OMPs), one of which is a 70-kilodalton (kDa) major OMP . After immunization of mice with outer membrane preparations of iron-depleted cells of strain H44/76 (B:15:P1.7,16), hybridoma cell lines producing monoclonal antibodies against the 70-kDa OMP were obtained . Some of these monoclonal antibodies demonstrated strong bactericidal activity against the homologous strain H44/76 in the presence of human complement, suggesting potential application of the 70-kDa OMP as a vaccine component . However, none of the 10 selected monoclonal antibodies was able to recognize the corresponding protein from five heterologous strains of various serosubtyping characteristics . A polyclonal anti-70-kDa OMP serum also did not react with the other strains . This result shows that immunodominant surface-exposed epitopes of the meningococcal 70-kDa iron-limitation-inducible OMP are strain specific.

Tidsskr Nor Laegeforen, 1990 Aug 30, 110(20), 2629 - 33
{Clinical manifestations caused by group A streptococci}; Brandtzaeg P et al.; We describe the symptomatology of different disease entities caused by group A beta-hemolytic streptococci (Streptococcus pyogenes, GAS) . The case histories of four patients, two of whom died, emphasize the severity of certain clinical manifestations of GAS-infections . A 34 year-old woman was admitted to hospital four days after start of the symptoms . She presented a clinical picture very similar to that observed in fulminant meningococcal septicaemia; i.e . extensive skin haemorrhages, circulatory collapse, and multiple organ failure . She died within 12 hours of admission . GAS were isolated in blood culture . A seven day-old girl died before admission to hospital . GAS were isolated in blood cultures, cerebrospinal fluid and from her nose and throat . An eight year-old, psychomotoric retarded girl developed a severe left-sided pneumonia, empyema and scarlatina . GAS were detected in throat culture . She responded poorly to high doses of benzylpenicillin given intravenously . She recovered rapidly after thoracotomy and decortication of her left lung . Finally, we describe the case of an 11 year-old boy with rheumatic fever without cardiac involvement . The reported cases underline the need for careful diagnosis and penicillin treatment in cases of GAS-infections.

Ann Rheum Dis, 1990 Aug, 49(8), 634 - 5
Primary meningococcal arthritis associated with adult respiratory distress syndrome; Samanta A et al.; A previously fit and well 20 year old man with primary meningococcal arthritis of the left knee is described . Despite intensive search there was no evidence of extra-articular meningococcal infection . He subsequently developed adult respiratory distress syndrome as a rare and previously undescribed complication.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Aug, (8), 53 - 7
{Infectious disease mortality in the USSR}; Shakhanina IL et al.; In recent decades infectious and parasitic diseases (class 1 according to the International Classification of Diseases-9) constitute 2-3% of causes in the total morbidity structures in the USSR . The main causes of death among diseases of class 1 are tuberculosis (37%), acute enteric infections (30%), septicemia (11%), viral hepatitides (11%), meningococcal infection (4%), measles (2%) . The main groups are children aged up to 2 years (48% of fatal cases of diseases belonging to class 1) . The territorial irregularity of mortality indices has been revealed.

J Surg Res, 1990 Aug, 49(2), 186 - 96
Laboratory models of sepsis and septic shock; Fink MP et al.; That there are so many models of sepsis and septic shock is tacit evidence that none of them are perfect . Although sepsis presents in many forms clinically, most clinicians would probably agree that virtually all severely septic patients manifest respiratory failure and ventilator dependence . Furthermore, failure of organs other than the lungs typically occurs days to weeks after the onset of the septic process . Although early deaths occur commonly in some situations (e.g., meningococcemia, pneumococcal bacteremia in asplenic individuals, Gram-negative bacteremia in the setting of profound granulocytopenia), most deaths due to sepsis occur after a protracted course in an intensive care unit . Thus, for certain important experiments, there is a need for an animal model of severe chronic sepsis characterized by these features: persistent hypermetabolism, low systemic vascular resistance, respiratory failure severe enough to require mechanical ventilation, late (nonpulmonary) organ system failure, and death . Obviously, creation of such a model will require a major commitment of resources, because it will require, in essence, the creation of an animal intensive care unit . Nevertheless, we believe that progress in sepsis-related research would be substantially facilitated were such a model available . Even without such a model, progress will continue in this field . A wide variety of good animal models are already available to investigators . In the next decade, as new methods, such as the powerful tools of molecular biology, are applied to problems related to the sepsis syndrome, these models will be invaluable in improving our understanding of pathophysiology and in developing new and more effective approaches toward therapy.

Enferm Infecc Microbiol Clin, 1990 Aug-Sep, 8(7), 420 - 5
{Meningococcal disease in the province of Córdoba (1983-1987}; Martinez de la Iglesia J et al.; This study reports the clinico-biologic characteristics, complications and the final events in 224 cases of meningococcal disease observed during a period of five years in the province of Cordoba . The prognostic factors of the disease were also evaluated . Patients were divided into three groups according to the diagnosis: meningitis, meningococcemia, and meningitis with meningococcemia . The incidence of each group was 18%, 22% and 60%, respectively . The 81.7% of the patients were below the age of 14 years . The most frequent symptoms were the fever (97.8%), vomitus (75%) and headache (52.2%) The more common exploratory findings were petechiae (76.8%) and nuchal rigidity (53.6%) . Complications related to the illness were present in 27.3% of the cases . The clinical course showed a mortality rate of 6.3% with a complete recovery in 91% of patients . Sequelae was present in 2.7% of the cases . The absence of previous antibiotic therapy (p < 0.05), the presence of nuchal rigidity (p < 0.05), shock (p < 0.01), coma (p < 0.05), leukocytopenia (p < 0.001), and a prothrombin activity lower than 70% (p < 0.05) were associated with a bad prognosis.

Offentl Gesundheitswes, 1990 Aug-Sep, 52(8-9), 448 - 50
{Practical approach according to the Federal Infection Legislation in meningococcal diseases in community facilities from the viewpoint of Public Health physicians in Offenburg}; Weber E; Within the area for which the Public Health Office Offenburg is in charge, numerous meningococcal diseases in childhood occurred in 1988 . As a result there of, a new strategy for the control of meningococcal diseases in day-care centers has been developed . In this respect priority has been given to rapid mutual information among the persons involved together with the strict control and supervision of all contact persons . This strategy led to an acceptable compromise for all persons involved; the strategy aims at achieving scientific accuracy and legal correctness, it is transparent and reproducible, and is easily implemented from an organisational point of view.

J Med Microbiol, 1990 Aug, 32(4), 275 - 81
Immunogenicity and cross-reactivity of the 70-Kda iron-regulated protein of Neisseria meningitidis in man and animals; Ala'Aldeen DA et al.; The immune response to different serogroups and serotypes of N . meningitidis has been examined in acute and convalescent sera from patients with meningococcal diseases . The focus of the study was the c . 70-Kda iron-regulated outer-membrane protein (FeRP-70) . FeRP-70 was demonstrated on all strains of different serogroups and serotypes examined by sodium dodecylsulphate-polyacrylamide gel electrophoresis or Western blots of outer-membrane proteins (OMPs) . Immunoblotting experiments demonstrated the presence of considerable amounts of anti-FeRP-70 IgG antibodies in the acute and convalescent sera of six patients; the antibodies reacted with homologous and heterologous strains . However, sera from two patients who died of severe meningococcal septicaemia had no antibodies against FeRP-70 or any other OMPs demonstrable by immunoblotting . Absorbed rabbit hyperimmune sera reacted with FeRP-70 of their homologous strains, but, unlike human sera, with only a few of the heterologous strains . We believe that FeRP-70 is strongly immunogenic in vivo, cross-reactive amongst different strains, and that man and animals differ considerably in their response to similar meningococcal antigens . The functional attribution of human antibody response against this protein requires further exploration.

Epidemiol Infect, 1990 Aug, 105(1), 119 - 26
Serotype-specific outbreak of group B meningococcal disease in Iquique, Chile; Cruz C et al.; From 1979 to August 1987, there have been 178 cases of meningococcal disease in Iquique, Chile, a city of about 140,000 . The attack rate for the last 5 years has been in excess of 20/100,000 per year, more than 20 times greater than for the country overall . The mortality rate was 6% . The disease occurred in patients with ages from 4 months to 60 years, but 89% of cases were in patients less than 21 years . The largest number of cases were in the age group 5-9 years (n = 54), but the highest incidence occurred in children less than 1 year of age (72.8/100,000 per year) . The male/female ratio was 1.2 . Cases occurred all year round with little seasonal variation . Of the 178 cases, 173 were biologically confirmed . Serogroup analysis of strains from 135 patients revealed A = 1, B = 124, C = 10 . Forty-four group B strains from 1985-7 were serotyped: 15:P1.3 = 36, 15:NT = 4, 4:P1.3 = 2, NT:NT = 2 . Ten of 11 of the outbreak strains tested were sulfadiazine-resistant . This is the first recognized outbreak caused by a Gp B:15 strain in South America . It shares many of the characteristics of outbreaks caused by closely related strains in Europe, such as a predilection for older children and adolescents, sulfadiazine-resistance, and sustained high attack rates . The Iquique strain (B:15:P1.3) belongs to the same genetic clone (ET-5 complex) as the Norway (B:15:P1.16) and the Cuban (B:4:P1.15) strains.

J Clin Microbiol, 1990 Aug, 28(8), 1711 - 9
Characterization of epidemic and nonepidemic Neisseria meningitidis serogroup A strains from Sudan and Sweden; Salih MA et al.; A random selection of 25 strains isolated during an epidemic caused by serogroup A Neisseria meningitidis in Sudan (1988), 3 preepidemic meningococcal strains (1985), and 26 serogroup A strains isolated from sporadic cases of meningitis in Sweden (1973 to 1987) were assessed for multilocus enzyme genotypes (ETs), DNA restriction enzyme patterns, outer membrane proteins, lipopolysaccharides, pilus formation, and antibiograms . All of the 25 Sudanese epidemic isolates and 22 of the Swedish strains were of the same or closely related ETs (ETs 3, 4, and 5), corresponding to clone III-1, which has been responsible for two pandemic waves in the last three decades . The earlier pandemic involved Scandinavia, and the last one caused an outbreak during the pilgrimage to Mecca, Saudi Arabia (August 1987), spreading to Sudan, Chad, and Ethiopia . The three Sudanese preepidemic isolates (1985) were clone IV-1 (sulfonamide susceptible), which has been resident in the African meningitis belt for the last 25 years . The uniformity of clone III-1 strains (all sulfonamide resistant) from Sudan and Sweden was confirmed by DNA restriction enzyme patterns . ETs 3, 4, and 5 from Sudan and Sweden had 86 to 100% similarity to a Swedish clone III-1 reference strain, whereas ETs 1, 2, 6, and 7 showed 50 to 80% similarity . Class 1 protein for clone III-1 showed serosubtype antigens P1.9 and P1.x, whereas ET6 strains (clone IV-1) had serosubtype P1.7 . Lipopolysaccharides were variable in the Sudanese and Swedish strains . Pili were expressed in all clone III-1 isolates from Sudan and Sweden but in none of the clone IV-1 isolates (Sudan, 1985).

Wiad Lek, 1990 Jul 15, 43(14), 710 - 3
{Epidemiology and treatment of purulent meningitis in children}; Modzelewska I; The results are reported of the treatment of purulent meningitis in the years 1980-1987 . The treated group comprised of 49 children aged from 2 months to 4 years . The most frequent cause was meningococcal infection . All children recovered, only in 6 youngest ones subdural hygroma remained and was emptied by punctures . The treatment included penicillin and sulphonamides, in normally used doses . Frequent lumbar taps were avoided since they traumatize the meninges . The treatment was continued 3 days after temperature fall . It was observed that bacteria attacked already in the perinatal period the damaged brain tissue.

J Infect, 1990 Jul, 21(1), 21 - 5
Group A meningococcal disease in England associated with the Haj; Jones DM et al.; An outbreak of group A meningococcal infection amongst the Muslim population in England followed the outbreak of meningococcal disease associated with the 1987 Haj to Mecca . There were 18 primary cases amongst pilgrims returning from Mecca and 15 subsequent cases among Muslims over the following 19 months . The meningococcal strains were shown to be of the same clone as strains from the Mecca outbreak by possession of an outer membrane protein PI.9 . Strains of this group A clone (A III-I) had only rarely been encountered in England before this outbreak.

J Pediatr Orthop, 1990 Jul-Aug, 10(4), 549 - 50
Distal tibial physeal arrest: a complication of meningococcal septicemia; O'Sullivan ME et al.; Two cases of meningococcal septicemia are presented . Distal tibial physeal arrest occurred in both cases due to hypotension and disseminated intravascular coagulation . To our knowledge, this is the first report of distal tibial physeal arrest with resultant varus deformity at the ankle subsequent to meningococcal septicemia.

Arch Roum Pathol Exp Microbiol, 1990 Jul-Sep, 49(3), 215 - 21
Characteristics of Neisseria meningitidis strains isolated in Romania between 1986 and 1989; Dorobat O et al.; 499 N . meningitidis strains were studied, 454 being isolated from CSF and blood and 45 from nasopharynx . Meningococcal serogroup A was prevalent in 1986-1988, having a decreasing tendency from 84.90% in 1987 to 45.0% in 1989 . Serogroup C increased from 0.86% in 1986 to 15% in 1989 . All strains, examined by diffusiometric method, were sensitive to ampicillin, cephalotin, chloramphenicol and rifampin . For tetracycline, resistance ranged from 2.28 to 6.0% in 1987-1989 . The frequency of 52.0-72.14% resistant to sulphamides strains seems to be due to serogroup A prevalence . Six N . meningitidis strains, isolated in 1989, proved to be moderately resistant to penicillin with MIC greater than or equal to 0.1 mcg/ml . The results indicate the necessity of a continuous surveillance of meningococcal infection, both from the point of view of serogroup circulation and also of antibiotics sensitivity.

Microbiologica, 1990 Jul, 13(3), 225 - 9
The effect of meningococcal group A and C polysaccharide vaccine on nasopharyngeal carrier state; Stroffolini T et al.; The effect of Neisseria meningitidis group A and C polysaccharide vaccine on nasopharyngeal carriage was studied in Italian army recruits . Throat swabs were cultured for N . meningitidis at the time of vaccination (one week after entry to service) and again three weeks later in a follow-up cohort of 98 men . At the first survey the overall carriage rate was 32% with 9% of isolates due to serogroup C, none to serogroup A and 17% to serogroup Y . At the second survey the overall carriage rate reached 52% (P less than 0.01); no isolate belonged to serogroup A or C, while serogroup Y reached 40% (P less than 0.01) . The cumulative carriage rate was 65% . Out of the 64 carriers during the whole study period, only 7 (11%) belonged to the same serogroup during the two different surveys . The vaccination appears to influence the carriage rate of meningococcal specific serogroups . The inhibition of serogroups A and C is, however, offset by an increased prevalence of meningococci belonging to serogroup Y.

Vojnosanit Pregl, 1990 Jul-Aug, 47(4), 237 - 41
{Meningococcal carrier state and meningococcal diseases in a military unit}; Pokorni D; In four recently formed military units pharyngeal meningococcal carrier state and dynamics of nasopharyngeal meningococcal infections have been examined . Carrier state found in at least 50% of recruits at their entering the army has been increased during the first two months for 10-26.4% and it was associated with very significant dynamics of meningococcal infection: changes in carrier state during the first two months have been found in 61.3% of soldiers with very marked changes in distribution of some meningococcal serologic groups among isolated species . Two months later stagnation and lower percentage of the carrier state was observed together with reducing dynamics of meningococcal infection . Meningococcal disease did not occur in the examined environment and this was explained by the absence of virulent meningococcal serotypes . It was concluded that in the risk for meningococcal disease evaluation final identification of meningococcal species isolated from patients and their contacts should be made aiming to timely detection of species known to have significant degree of virulence.

Mol Microbiol, 1990 Jul, 4(7), 1215 - 8
Generation of capsule-deficient Neisseria meningitidis strains by homologous recombination; Frosch M et al.; Capsule-deficient mutants of Neisseria meningitidis serogroup B strain B1940 were constructed by allelic replacement using the plasmids pMF120 and pMF121, which contain the flanking regions of the gene locus for the biosynthesis pathway of the group B meningococcal capsular polysaccharide . Southern blot analysis of chromosomal DNA of the capsule-deficient meningococcal strains confirmed the generation of large deletions in the chromosomal cps gene complex . The same strategy proved useful in constructing meningococcal strains with capsular types A, C, W135, Y and Z.

Med Lab Sci, 1990 Jul, 47(3), 158 - 62
Apparent failure of brain heart infusion broth to cultivate meningococci from clinically infected patients; Glaister D et al.; Brain Heart Infusion broth is a widely used medium for the isolation of pathogenic bacteria from body fluids . Cerebro spinal fluid and blood inoculated into this medium from clinically meningitic infants infected with Neisseria meningitidis appeared not to support the growth of this organism . In laboratory experiments the broth did not support the growth of Neisseria meningitidis unless adequately vented and with addition of blood . Thorough mixing was necessary to disperse microcolonies that formed in the base blood layer of blood cultures . When this was done they were isolated using standard sub-culture techniques . Broths used for specimens other than blood must be used with blood or a blood supplement if this organism is suspected, and should be incubated aerobically or vented to 5% carbon dioxide, and thoroughly mixed . Awareness of these deficiencies may prevent false negative results.

J Adolesc Health Care, 1990 Jul, 11(4), 355 - 7
Meningococcal urethritis; Faigel HC; Two to four percent of the population carry meningococcus in the nasopharynx . Pharyngeal infections may be the entry point for blood-borne metastatic lesions throughout the body . Primary infections in other tissues are rare, and proof of transmission from a known carrier to a specific patient is uncommon . We report a primary infection of the urethra with the meningococcus in a heterosexual male contracted during an act of fellatio.

Patol Fiziol Eksp Ter, 1990 Jul-Aug, (4), 40 - 1
{Lipid peroxidation in the blood of patients with suppurative meningitis}; Roslyi IM et al.; It is shown that the dynamics of lipid peroxidation (LPO) in patients with purulent meningitis is unspecified in character and is encountered both in meningococcal and pneumococcal infection . The level of secondary LPO products and the degree of hyperfermentemia, which are determined according to the dynamics of changes in the activity of aspartate transaminase, are objective characteristics of the severity of the patient's condition and reach maximum on the 5th day of the disease . The correlation between the dynamics of the primary LPO products and the ceruloplasmin/transferin coefficient allows the severity of the disease to be prognosticated.

Infect Immun, 1990 Jul, 58(7), 2204 - 13
Measurement of the human immune response to meningococcal lipooligosaccharide antigens by using serum to inhibit monoclonal antibody binding to purified lipooligosaccharide; Estabrook MM et al.; We developed a human inhibition monoclonal enzyme-linked immunosorbent assay (HIMELISA) to investigate the human immune response to the lipooligosaccharides (LOS) of Neisseria meningitidis . Monoclonal antibodies (MAb) were used to define seven epitopes on four LOS molecules of a meningococcal strain (126E) previously shown to express immunogenic LOS epitopes . The assay could distinguish epitope-specific antibody within whole sera . Neither the specificity nor the amount of the antibody measured by HIMELISA in sera of vaccinates changed during the immune response to meningococcal capsular polysaccharides, a chemically unrelated antigen . By using the HIMELISA, it was determined that sera from adults convalescing from meningococcal disease strongly inhibited MAb binding to two of the seven defined epitopes . The 3.6-kilodalton LOS of strain 126E expressed both of these epitopes . In addition, one of the inhibited epitopes was also expressed on the 4.0-kilodalton LOS of strain 126E . The convalescent-phase sera inhibited MAb binding to these two epitopes when they were expressed on LOS of diverse meningococcal strains . An acute-phase serum blocked MAb to the two epitopes to a lesser degree than did a convalescent-phase serum from the same patient . Immunoblotting the sodium dodecyl sulfate-polyacrylamide gel electrophoresis-separated LOS with convalescent-phase sera confirmed the specificity of the human anti-LOS antibody identified by HIMELISA.

Zhonghua Liu Xing Bing Xue Za Zhi, 1990 Jun, 11(3), 167 - 9
{Rapid diagnosis of epidemic cerebrospinal meningitis by co-agglutination}; Gao EM; Group A meningococcus polysaccharide antigen from cerebrospinal fluid (CSF), serum and urine were detected by Co-agglutination (COA) method . In total 478 samples, CSF, sear and urines 195, 214, and 69 samples were detected respectively . COA positive rate of CSF were 81.2%, serum were 64.6% and urine were 50%, in the patients from whom group A bacteria were isolated, but the samples from which group B meningococcus, pneumococcus or other isolates positive showed negative in COA . A good sensitivity and specificity of COA method have been proved in this paper . The advantages of COA method were rapid, simple and could be easily performed in ordinary laboratory conditions.

Aten Primaria, 1990 Jun, 7(6), 426 - 31
{An epidemiological study of meningococcal disease in the province of Cordova (1983-1987)}; Martinez de la Iglesia J et al.; To more precisely define the epidemiological characteristics of meningococcal disease (MD) and to try to determine its possible risk factors, 224 cases diagnosed during the 1983-1987 period in all the hospitals of the Cordova province were evaluated . There was an incidence density (ID) of 6 cases/100,000/year . The younger ages were the most commonly involved (81.7% of cases were less than 14 years old), and males had the highest overall incidence . The greatest number of cases accumulated during the coldest months of the year (december, january, february) . The highest rate of incidence was in the Guadalquivir Valley area, which has the highest population density . The poorest and socioeconomically lowest districts of the capital had the greatest morbidity (p less than 0.001) . The mortality rate was 6.2% . It was higher in patients over 5 years of age and the male/female mortality rate was 0.75 . It was concluded that wider and deeper epidemiological studies are required to evaluate the influence of habitat and other possible factors in the development of MD.

Microb Pathog, 1990 Jun, 8(6), 411 - 9
The thymus-dependent nature of the murine antibody response to a monoclonal anti-idiotypic antibody to the Neisseria meningitidis serogroup C capsular polysaccharide; Westerink MA et al.; Idiotype vaccines are proteins which may offer an alternative strategy for the conversion of a thymus-independent antigen into a thymus-dependent immunogen . To examine this question, we have studied the nature of the immune response to a monoclonal anti-idiotypic antibody, designated 6F9, which acts as a surrogate of Neisseria meningitidis serogroup C capsular polysaccharide, and compared this response to the nominal antigen, the meningococcal C-polysaccharide (MCP) . BALB/c mice immunized with an optimal dose (100 micrograms) of 6F9 generate a specific anti-MCP IgG response which is maximal after 4 weeks . Secondary immunization with 6F9 results in a three- to five-fold increase in the specific IgG response . Mice given an optimal immunizing dose of MCP (5 micrograms) failed to generate an anti-MCP IgG response . No secondary response is detectable in mice immunized with MCP . Animals immunized with 6F9 and subsequently challenged with live meningococci group C show a significant anti-MCP IgG response . BALB/c nu/nu mice fail to generate an anti-MCP IgG antibody response to 6F9, while the nu/+ controls generate an anti-MCP IgG antibody titer 100 times that of the MCP-immunized mice . Neonatal mice that failed to respond to MCP developed early IgM and a subsequent IgG anti-MCP response after immunization with 6F9 . These data demonstrate that the anti-idiotype 6F9, the combining site of which contains a surrogate image of the meningococcal group C capsular polysaccharide, evokes the responses expected of a T-dependent antigen.

APMIS, 1990 Jun, 98(6), 521 - 8
Neisseria meningitidis group B capsular polysaccharide . Bacterial content and release in relation to categories of infection and filtrability of released endotoxin; Hoddevik GM et al.; A total of 41 Neissera meningitidis isolates were analyzed for capsular polysaccharide (CP) and lipopolysaccharide (LPS) release and filtrability . Twenty-two of these isolates were serogroup B from blood or cerebrospinal fluid of patients, five were group B isolates from healthy throat carriers, and 14 were nongroupable (acapsular) meningococcal isolates from healthy carriers . Filtration of liquid whole-cell cultures through cellulose acetate-nitrate filters resulted in distinctly lower LPS filtrate activity for acapsular than for capsular meningococci (p less than 0.001) . On the other hand, when polysulfone membrane filtration was performed, filtrates from acapsular and capsular meningococci contained LPS in similar amounts . These results indicate that LPS-containing particles released from acapsular isolates are larger or more aggregated than corresponding CP- and LPS-containing particles released from capsular isolates . The LPS released from acapsular isolates apparently are more efficiently retained by adsorption to cellulose acetate-nitrate . From the capsular isolates comparatively more CP than LPS appeared to be released, as related to cell-bound amounts . The total amounts of CP and released, filtrable LPS through cellulose acetate-nitrate filters were both relatively low and had similar values for capsular carrier meningococci and systemic isolates from mild meningococcal disease . The amount of CP released and passing this type of membrane was significantly higher for systemic isolates from severe septicemia than from mild meningococcal disease (p = 0.03).

APMIS, 1990 Jun, 98(6), 501 - 6
Serogroup determination of Neisseria meningitidis by whole-cell ELISA, dot-blotting and agglutination; Rosenqvist E et al.; Two new methods for serogrouping of meningococci, whole-cell ELISA and dot-blotting, with monoclonal antibodies against serogroups A, B, C, Y and W135 were compared with slide-agglutination applying polyclonal sera . In addition to a panel of strains with previously determined serogroups by slide-agglutination, two strain collections of meningococci were studied: 1) 50 strains isolated from patients with systemic meningococcal disease in Norway during the winter 1987-1988; 2) 133 throat strains isolated from asymptomatic carriers over the same period . For the disease strains all three methods gave identical results, whereas some carrier strains which were non-agglutinable or polyagglutinable by slide-agglutination were serogroupable by the two other methods . All the systemic strains and about half of the carrier strains were serogroupable . We find that whole-cell ELISA and dot-blotting are specific, easy to read and more sensitive compared to slide-agglutination, but the former methods are at present limited by the availability of monoclonal antibodies against only serogroups A, B, C, Y and W135.

Anal Biochem, 1990 Jun, 187(2), 349 - 54
Solid-phase synthesis and applications of N-(S-acetylmercaptoacetyl) peptides; Drijfhout JW et al.; The reagent pentafluorophenyl S-acetylmercaptoacetate was used to modify the N-terminus of resin-bound side-chain-protected peptides . The modification was carried out in an automated cycle in the final stage of fluorenylmethoxycarbonyl (Fmoc)/polyamide-mediated solid-phase synthesis . Side-chain deprotection and cleavage from the resin with aqueous trifluoroacetic acid gave the N-(S-acetylmercaptoacetyl) peptides . The S-acetylmercaptoacetyl peptides were transformed into reactive thiol-containing peptides by incubation with hydroxylamine at neutral pH . The S-deacetylation was performed in the presence of a sulfhydryl-reactive compound (or intramolecular group) to enable immediate capture of the sensitive thiol . Three applications were investigated . An S-acetylmercaptoacetyl peptide, containing a sequence of a meningococcal membrane protein, was incubated with hydroxylamine in the presence of 5-(iodoacetamido)fluorescein to give the corresponding fluorescein-labeled peptide in 62% yield . The same peptide was also S-deacetylated in the presence of bromoacetylated poly-L-lysine to afford a peptide/polylysine conjugate . Finally, a peptide corresponding to a sequence of herpes simplex virus glycoprotein D was prepared . This peptide, containing an N-terminal-S-acetylmercaptoacetyl group and an additional C-terminal S-(3-nitro-2-pyridinesulfenyl)cysteine residue, was converted into a cyclic disulfide peptide (20%).

Pediatr Infect Dis J, 1990 Jun, 9(6), 394 - 8
Risk factors associated with a school-related outbreak of serogroup C meningococcal disease; Morrow HW et al.; An outbreak of Neisseria meningitidis sero-group C disease occurred in four eighth grade students and in a younger sibling of another eighth grade student attending an intermediate school (seventh and eighth grades) in Santa Clara County, CA . Four cases had onset within 3 days in January, 1989, with the fifth case occurring approximately 10 days later . A case-control study was performed to determine risk factors associated with serogroup C meningococcal infection (disease or carriage) in this eighth grade class . Students were more likely to be infected if they had had a preceding viral-like respiratory illness characterized by fever (odds ratio (OR) 5.3, P = 0.03) or cough (OR 5.1, P = 0.048) . A ski trip (OR 6.3, P = 0.01) and a poster-making session for a school dance (OR 3.7, P = 0.08) were identified as possible settings for a common exposure . Spending time with two specific students during lunchtime or outside of school was associated with an increased risk of infection (OR 7.0, P = 0.054; OR 5.8, P = 0.04).

Eur J Clin Microbiol Infect Dis, 1990 Jun, 9(6), 421 - 4
Superoxol and aminopeptidase tests for identification of pathogenic Neisseria species and Moraxella (Branhamella) catarrhalis; Perez JL et al.; The superoxol test, and prolyl aminopeptidase and gammaglutamyl aminopeptidase tests were evaluated for the detection of pathogenic Neisseria spp . using 317 strains of Neisseria-ceae . The superoxol test was positive for all 116 gonococci and 62 Moraxella (Branhamella) catarrhalis strains, but also for three strains of Neisseria meningitidis, one strain of Neisseria lactamica and eight saprophytic neisseriae . When using strains grown on Thayer-Martin medium, the positive and negative predictive values of the superoxol test for the identification of Neisseria gonorrhoeae were 96.7% and 100% respectively . Meningococci were the only neisseriae growing on Thayer-Martin medium that showed gamma-glutamyl aminopeptidase activity . The prolyl aminopeptidase test showed low specificity.

J Exp Med, 1990 Jun 1, 171(6), 1871 - 82
Deduced amino acid sequences of class 1 protein (PorA) from three strains of Neisseria meningitidis . Synthetic peptides define the epitopes responsible for serosubtype specificity; McGuinness B et al.; The previously determined nucleotide sequence of the porA gene, encoding the class 1 outer membrane protein of meningococcal strain MC50, has been used to clone and sequence the porA gene from two further strains with differing serosubtype specificities . Comparison of the predicted amino acid sequences of the three class 1 proteins revealed considerable structural homology with major variation confined to two discrete regions (VR1 and VR2) . The high degree of structural homology between the sequences gave predicted secondary structures that were almost identical, with the variable domains located in hydrophilic regions that are likely to be surface located and hence accessible to antibody binding . The predicted amino acid sequences have been used to define the epitopes recognized by mAbs with serosubtype specificity . A series of overlapping decapeptides spanning each of the class 1 protein sequences have been synthesized on solid-phase supports and probed with mAbs . Antibodies with P1.16 and P1.15 subtype specificity reacted with sequences in the VR2 domain, while antibodies with P1.7 subtype specificity reacted with sequences in the VR1 domain . Further peptides have been constructed to define the minimum epitopes recognized by each antibody . Thus we have been able to define linear peptides on each class 1 protein molecule that are responsible for subtype specificity and that represent targets for a protective immune response.

Lancet, 1990 May 19, 335(8699), 1182 - 4
Identification of a UK outbreak strain of Neisseria meningitidis with a DNA probe; Knight AI et al.; To investigate the epidemiology of meningococcal disease, a specific DNA probe pUS210 (carrying insert DNA which is repeated in the meningococcal genome) was isolated . The ability of this probe to hydridise with multiple polymorphic fragments in Southern blots was exploited to examine genetic relations within strains . Two geographically distinct foci of prolonged meningococcal disease (Gloucester and Plymouth, UK) are due to a clonal population of virulent strains that are distinct from those found elsewhere in the UK.

Ugeskr Laeger, 1990 May 7, 152(19), 1360 - 2
{Meningococcal disease in the Faroe Islands during the period 1978-1985}; Mathiassen B et al.; On the Faroe Islands (45,000 inhabitants), a total of 203 cases of meningococcal disease (MD) were recorded during the period 1978-1985 . The peak incidence was 95/100,000 in 1981 . MD mainly attacked children, 30% were below two years and 75% were below 11 years of age . The lethality rate was 5.4% (11 deaths) . In 1981, rifampicin was introduced as a prophylactic treatment against secondary cases and at the same time, a decrease in incidence occurred . The decrease was more pronounced in the part of the country where the number of prescribed prophylactic doses per case of MD was greatest . These observations indicate that the introduction of rifampicin may have modified the course of the epidemic . None of the MD-patients had received prophylactic treatment with rifampicin . Of 132 examined, one patient with complement deficiency was identified, indicating that complement deficiencies were not a major risk factor in the epidemic of MD on the Faroe Islands.

Ugeskr Laeger, 1990 May 7, 152(19), 1357 - 9
{Meningococcal infection and arthritis}; Christensen C; Arthritic manifestations in patients with meningococcal disease are of varied pathogenesis . Four different pathogenic mechanisms may be involved . Direct bacterial invasion of the synovium and multiplication within the joint (septic arthritis); hypersensitivity reaction or allergic arthritis; intra- or periarticular hemorrhage (hemarthrosis) and iatrogen causes, i.e . reaction to antimicrobial agents, serum therapy etc . Four distinct clinical forms have been described: The septic, culture-positive polyarthritis is seen early in the course of the disease . The sterile "non-infectious" or allergic mono- or oligo arthritis are seen later in the course . Primary meningococcal arthritis . Arthritis may be seen in relation to chronic meningococcemia . Treatment consists primarily of specific antimeningococcal chemotherapy, viz penicillin and non-steroid-anti-inflammatory drugs . The prognosis of meningococcal arthritis is excellent and joint sequelae are rare . Predisposing factors in relation to meningococcal disease are reviewed . The most important are socioeconomic conditions, acute respiratory illness, particularly in relation to age as children less than two years are most susceptible, passive smoking, IgA blocking antibodies, the concentration of complement factors C3, C6, C7, C8, and IgG2-defects.

Ugeskr Laeger, 1990 May 7, 152(19), 1362 - 5
{Meningococcal disease: are patients carriers of meningococci after treatment with antibiotics?}; Weis NM et al.; The aim of the study was to determine whether patients treated for meningococcal disease carried meningococci in the throat on discharge from hospital . If this were the case, supplementary treatment with e.g . rifampicin would be appropriate . The study comprised 106 patients: 98 patients in whom meningococci had been isolated from cerebrospinal fluid, blood or petechiae and eight patients with clinical signs of meningococcal disease in whom meningococci had been isolated only from tracheal aspirate or throat specimens . In 35% (22/62), meningococci were isolated from throat specimens on admission to hospital . From 20 throat specimens inoculated on 5% horse blood agar only, one meningococcal isolate was recovered (5%) . From further 37 specimens inoculated on chocolate agar medium selective for pathogenic Neisseria, 18 meningococcal isolates were recovered (49%) . This difference is statistically significant (p = 0.001) . Meningococci were not isolated from any throat specimens taken on discharge from hospital; 90% (47/52) of these specimens were examined using selective chocolate agar medium . From an observed carriage rate of zero out of 47 it can be judged that the carrier rate does not exceed 6.4% (95% confidence limit) . From these results, we conclude that it is unlikely that patients, who have been treated for meningococcal disease, are the source of infection in secondary cases.

Mol Microbiol, 1990 May, 4(5), 729 - 35
Transposition of Tn916 to different sites in the chromosome of Neisseria meningitidis: a genetic tool for meningococcal mutagenesis; Kathariou S et al.; The difficulty in obtaining mutants in pathogenic Neisseria has limited the ability to genetically define determinants responsible for virulence as well as the ability to generate a genetic map . We show that the 16.5kb conjugative transposon Tn916 can be introduced into Neisseria meningitidis on the suicide vectors pAM120 and pAM170 . After introduction, Tn916 transposed to different sites in the chromosome of recipient meningococci, apparently at random, and was stably incorporated . Following its integration into the meningococcal chromosome, Tn916 did not appear to readily express its conjugative and transpositional functions . However, chromosomal DNA from Tn916-carrying meningococci could be used to transform other meningococcal strains to tetracycline resistance . These studies indicate that Tn916 may be an important tool for genetic analysis of N . meningitidis.

Infect Immun, 1990 May, 58(5), 1355 - 9
Isolation of Neisseria meningitidis mutants deficient in class 1 (porA) and class 3 (porB) outer membrane proteins; Tommassen J et al.; The class 1 major outer membrane protein of Neisseria meningitidis is a serious candidate for a meningococcal vaccine . To facilitate studies on the function of this protein, mutants were isolated that lacked this protein or the structurally related class 3 protein . These mutants were obtained by using the antibody-dependent bactericidal action of the complement system . The class 1 protein-deficient strain grew normally in vitro, whereas growth of the class 3 protein-deficient strain was slightly retarded . The class 3 protein-deficient strain displayed increased resistance to the antibiotics tetracycline and cefsulodin, which is consistent with the proposed role of the protein as a pore-forming protein . The class 1 protein was purified to homogeneity from the class 3 protein-deficient strain . Lipid bilayer experiments revealed that this protein also formed pores . The class 1 protein pores were cation selective.

Mol Microbiol, 1990 May, 4(5), 769 - 76
Stable expression of meningococcal class 1 protein in an antigenically reactive form in outer membranes of Escherichia coli; White DA et al.; The entire gene encoding the class 1 outer membrane protein of Neisseria meningitidis is located on a 2.2kb fragment, obtained on digestion of chromosomal DNA with Xbal . This Xbal fragment from strain MC50 (subtype P1-16), which had previously been cloned in bacteriophage M13, has been transferred to the plasmid vector pMTL20 . The resulting plasmid (pPORA100) was propagated in Escherichia coli (JM109) and cell lysates were subjected to SDS-PAGE . Western blotting with anti-class 1 protein antibodies revealed constitutive expression of a protein of 41 kD, corresponding to the class 1 protein of the parent meningococcal strain, which was absent in the E . coli control . Fractionation of E . coli cells carrying the recombinant plasmid revealed that the protein was exclusively located in the outer membrane, and N-terminal amino acid analysis of the expressed protein revealed that normal processing of the signal peptide had occurred . Immuno-gold electron microscopy showed that the protective epitope recognized by a P1-16 subtype-specific monoclonal antibody was exposed in an antigenically reactive form on the surface of E . coli cells carrying plasmid pPORA100 . In contrast, expression in E . coli of a second plasmid (pPORA104) lacking the coding sequence for the first 15 amino acids of the signal peptide resulted in accumulation of recombinant class 1 protein only in the cytoplasm of the cells . Thus the presence of the meningococcal signal sequence ensures expression of this meningococcal porin protein in an antigenically native conformation in outer membranes of E . coli, while its absence results in expression of a soluble protein.(ABSTRACT TRUNCATED AT 250 WORDS)

J Clin Immunol, 1990 May, 10(3), 160 - 6
Antibacterial polysaccharide antibody deficiency after allogeneic bone marrow transplantation; Quinti I et al.; Allogeneic bone marrow-engrafted adults immunized with meningococcal types A and C and pneumococcal type 14 polysaccharide antigens showed only low antibody titers of the IgM class, no antibody titers of the IgG or IgA classes, and no bactericidal activity in vitro . The analytical isoelectrofocusing showed the appearance of a restricted pattern of clonotypes in a minority of subjects . These observations are consistent with the hypothesis that B cells in bone marrow transplant patients express some characteristics of neonatal B cells and suggest that polysaccharide-protein conjugates, rather than isolated polysaccharide, might be utilized in the setting of bone marrow transplantation.

Aust Fam Physician, 1990 May, 19(5), 757 - 9
Infectious diseases . Meningococcemia; Weinmann A; Late last year there was an increase in meningococcal disease in Melbourne and the author reviews the treatment procedures at the Alfred Hospital, Melbourne . The article is reprinted from the Alfred Hospital's Newsletter, which is edited by Dr Denis Spelman, Physician in Bacteriology.

J Infect Dis, 1990 May, 161(5), 932 - 7
Prophylaxis against Neisseria meningitidis infections and antibody responses in patients with deficiency of the sixth component of complement; Potter PC et al.; Forty South African patients with homozygous deficiency of the sixth component of complement (C6) have been identified in an area where group B meningococcal meningitis is endemic; 22 of the 24 proband cases presented with recurrent meningococcal meningitis . In a 2- to 4-year prospective study, patients with recurrent infections who received monthly prophylactic long-acting penicillin were significantly protected from subsequent neisserial infection compared with those who did not receive penicillin (P = .02, Fisher's exact test) . Heterogeneous susceptibility to neisserial infection was confirmed by following C6-deficient patients who presented with one or no Neisseria meningitidis infections . These patients, on no prophylaxis, had significantly fewer infections (P = .004) than did patients who presented with recurrent disease . Functional C6 activity was restored by transfusion of fresh frozen plasma in a C6-deficient patient resistant to conventional antibiotic treatment . Antibody levels to the serotype 2 outer membrane proteins were significantly elevated in C6-deficient patients compared with control groups (P = .001).

Carbohydr Res, 1990 Apr 25, 200, 59 - 76
Analysis of oligosaccharide epitopes of meningococcal lipopolysaccharides by fast-atom-bombardment mass spectrometry; Dell A et al.; A mass-spectrometric approach is presented for the analysis of the structures of lipopolysaccharide-derived oligosaccharides, which are frequently difficult to define by classical methods since they contain chemically labile components . The method involves f.a.b.-m.s . of the oligosaccharides, their peracetylated and permethylated derivatives, their deuterioacetylated and methylated analogues, and the fragments obtained during graded methanolysis of the methylated analogues . Data obtained from two representative meningococcal LPS oligosaccharides define the sequence, patterns of branching, and the extent and location of the phosphorylethanolamine and O-acetyl substituents.

Am J Med, 1990 Apr 9, 88(4A), 12S - 17S
Empiric therapy of severe infections in adults; Modai J; The third-generation cephalosporins are useful for empiric therapy of most of the severe infections in adults as a result of their broad spectrum of antimicrobial activity (particularly against clinically important gram-negative bacteria), good tissue penetration, and lack of serious adverse effects . This review examines their use in respiratory tract infections, bacterial meningitis, skin-structure infections, and urinary tract infections in adult patients . Penicillin G remains the optimal therapy for severe community-acquired pneumonia, since Streptococcus pneumoniae still accounts for the majority of cases . However, for empiric treatment of nosocomial pneumonia, therapy must ensure coverage both of aerobic gram-negative bacilli and Staphylococcus aureus . The choice of empiric antibiotic therapy in the treatment of urinary tract infections depends on the pattern of resistance in the patient's environment . At present, the treatment of bacterial meningitis in otherwise healthy adults does not constitute a major problem provided that penicillin resistance among pneumococci and meningococci (responsible for at least 80 percent of cases) does not become a clinical problem . However, in meningitis in which gram-negative bacilli are suspected and where specific problems include antibiotic resistance among these organisms and the inadequate penetration of many antibiotics into the cerebrospinal fluid, third-generation cephalosporins are the drugs of choice, and they have markedly improved the clinical outcome . Most skin-structure infections are due to S . aureus and are best treated by an anti-staphylococcal penicillin or an older cephalosporin . Nevertheless, the third-generation cephalosporins have proved to be highly effective agents for infections of skin and soft-tissue infections associated with both gram-positive and gram-negative pathogens in patients at risk from these organisms or in the elderly.

Postgrad Med J, 1990 Apr, 66(774), 302 - 3
Spinal cord dysfunction complicating meningococcal meningitis; Khan J et al.; A 29 year old male developed paraplegia during the acute phase of meningococcal meningitis . Possible mechanisms for this unusual complication are discussed and the literature regarding spinal cord complications of pyogenic meningitis is reviewed.

An Esp Pediatr, 1990 Apr, 32(4), 314 - 6
{Petechiae in children: a disturbing symptom}; Fernandez Gonzalez M et al.; Out of patients with petechial lesions attended during a 5 year period, 90 (45%) were diagnosed a meningococcal disease . The generalized distribution of the petechial lesions proved to be very helpful as an orientation about the disease . The presence of a series of altered laboratory determinations (white blood cell count, band cells count, erythrocyte sedimentation rate 1st hour . C reactive protein (PCR) in blood and blood coagulation study) was highly significant in patients with the disease mentioned before.

Epidemiol Infect, 1990 Apr, 104(2), 203 - 9
Secretor status, smoking and carriage of Neisseria meningitidis; Blackwell CC et al.; A survey of ABO blood groups, secretor status and smoking habits among 389 students and staff of a school in which there was an outbreak of meningococcal disease found no difference in the distribution of the ABO blood groups but a significantly higher proportion of non-secretors (37.6%) in the population examined compared with that reported for previous surveys of the neighbouring population in Glasgow (26.2%) (P less than 0.0005) . There was also a significantly higher proportion of non-secretors among carriers of meningococci (47%) compared with non-carriers (32%) . Increased carriage of meningococci among non-secretors might contribute to the increased susceptibility of individuals with this genetic characteristic to meningococcal disease observed in previous studies . Although passive exposure to cigarette smoke has been associated with meningococcal disease, there was no association between passive smoking and carriage . There was, however, a significant association between active smoking and carriage.

Clin Immunol Immunopathol, 1990 Apr, 55(1), 41 - 55
Combined complete C5 and partial C4 deficiency in humans: clinical consequences and complement-mediated functions in vitro; Gianella-Borradori A et al.; A family is described with two siblings who suffered at different times from a single episode of meningococcal meningitis by Neisseria meningitidis groups B and C, respectively . In the two subjects, hemolytically active fifth component of complement (C5) was not detectable and antigenic C5 was less than 0.05% and less than 0.7% of normal, respectively . Repletion of sera by purified human C5 (70 micrograms/ml) restored total complement hemolytic activities . The asymptomatic first degree family members had C5 levels compatible with a heterozygous state of C5 deficiency . C4 allotyping revealed an inherited partial deficiency (Q0) of C4A and C4B in the family with a combined C4AQ0 and C4BQ0 heterozygous condition in one and C4BQ0 heterozygosity in the other C5 deficient (C5D) subject . To our knowledge, this is the first human kindred with recognized combined C5 and C4 deficiency . No other defect of the humoral and cellular immune system was found in this family, including specific immune response to tetravalent meningococcal vaccine . The effect of partial C4 deficiency on classical pathway function was assessed by inhibition of immune precipitation (IIP) of forming bovine serum albumin (BSA)/anti-BSA immune complexes . Sera from all family members showed normal IIP values, with exception of the subject with combined partial deficiency in C4A, C4B, and complete deficiency in C5 . Despite undetectable functional C5 in the C5D sera, the titration of the alternative pathway indicated intact but deficient hemolytic activities when rabbit erythrocytes (EC) were used as indicator cells in the presence of Mg2+ and EGTA in an end-point or kinetic assay . Preincubation of the two sera at 0 degrees C for 60 min with rabbit ECs reduced alternative pathway hemolytic activity by 24 and 100%, respectively . When rabbit ECs were replaced by guinea pig ECs no alternative pathway function could be measured . The results indicate that the apparent functional activity of the alternative pathway in C5D sera strongly depends on a factor(s) present in such serum and/or on the detection system used . We conclude that the two C5D individuals of the family reported here may not have sufficient C5 activity to provide efficient protection against Neisserial infections in conditions where complement functions beyond C3 opsonic activity are required in vivo.

Med Interne, 1990 Apr-Jun, 28(2), 157 - 62
Possibilities of perfecting antimicrobial therapy . Dynamics of penicillin G concentrations in the cerebro-spinal fluid in purulent meningitis; Caruntu F et al.; In 43 adult patients with purulent meningitis receiving daily doses of 1-4,000,000 IU penicillin G i.v . in bolus, determinations were made, 1-6 hrs after administration, in 153 samples of cerebrospinal fluid (CSF), to ascertain the concentrations of penicillin that have reached the CSF . After 1 hour maximum levels of penicillin were noted, exceeding by far the meningococcus and pneumococcus minimum inhibitory concentration (MIC) . Generally, high penicillin concentrations persisted in the CSF, in most of the cases at least for the following 6 hours . The advantages of using penicillin G i.v . in doses of 1-3,000,000 IU in bolus at 12 hour intervals are discussed . All the 36 patients with meningococcal meningitis and 3 of the 5 with pneumococcal meningitis recovered with this therapeutic scheme, under daily control of the CSF.

Ann Pediatr (Paris), 1990 Apr, 37(4), 209 - 18
{Epidemiology of meningococcal infections and principles for the prevention of secondary cases}; Olivares R et al.; The incidence of meningococcal infections undergoes secular variations with modifications in the distribution of identified serotypes . Rhinopharyngeal carriage of meningococci, common in the community, is the natural means of immunization . Prevalence of this carriage varies across age groups and communities, as well as according to whether or not cases are present in the community under study . Identified factors that promote transmission of the bacteria include crowded living conditions, poor socioeconomic conditions, and, more controversially, respiratory tract viral infections . Development of meningococcal infection usually occurs within seven days of onset of carriage . Secondary cases account for approximately 3% of meningococcal infections in France . The risk of development of secondary cases is increased in subjects sharing the patient's home or exposed to his or her rhinopharyngeal secretions . Prevention of these secondary cases rests on chemoprophylaxis and immunization . The qualities of antimicrobial agents proposed for chemoprophylaxis are discussed, with special emphasis on spiramycin and rifampin which are the most widely used . This study, which rests on French epidemiologic surveillance findings and data from a review of the literature, forms the basis for new French guidelines.

Enferm Infecc Microbiol Clin, 1990 Apr, 8(4), 222 - 4
{Persistence and transmission of Neisseria meningitidis in a family with a case of fatal infection}; Saez Nieto JA et al.; We described two cases of meningococcal infection in a family . Both were detected in a period of seven months . We studied the epidemiological markers of strains isolated from cases and close contacts of the second case . The isolate of first case is identical to the rest of strains studied and we suggest the possibility of persistence and transmission of infection of the index case to the close contacts and the second case . In this paper it is discussed the application of control measures to eradicate the meningococcus from the nasopharynx of patients after the illness, principally in workers with close contacts with populations at risk and in epidemic periods.

Medicina (Firenze), 1990 Apr-Jun, 10(2), 129 - 33
{Meningococcal meningitis in Italy: 1887-1986}; Ballada D et al.; We report the epidemiological data relative to meningococcal meningitis observed through a century, 1887-1986, in Italy . It is evident both from mortality and morbidity data that in Italy three epidemic peaks have occurred in 1915-1918, in 1939-1943 and in 1968-1972 respectively . The first two epidemic episodes are likely to be connected with the World Wars, the third one, recorded in other european and non european countries, probably reflects a pandemic recrudescence of the disease . The case fatality rate has shown periodic fluctuations connected with the epidemics and an average value of 10% until the sixties . Since then, the case fatality rate has stably decreased below that value . The seasonal distribution of the disease is similar both in the epidemic or non-epidemic period, with the higher incidence of cases between December and April and the lowest in August . There are no substantial differences in the regional distribution of the disease among the various regions of Italy . The distribution of cases, according to the different age-groups (0-14, 14-25, greater than 25 years old), indicates that the disease is more prevalent among the first group . However, in the last decade it is evident a trend of reduction among this group and a relative increase in other groups, in particular in subjects older than 25 years . In addition, meningococcal meningitis is prevalent among the males in the first two decades of life (less than 25 years old) while, afterward, there is an equal incidence both in males and females . The higher prevalence suggests a role of various close environmental contacts, such as the military service.(ABSTRACT TRUNCATED AT 250 WORDS)

Biull Eksp Biol Med, 1990 Apr, 109(4), 369 - 71
{New approach to the diagnosis of meningococcal infection: latex-erythrocyte agglutination}; Martynov IuV et al.; A principal possibility and advantages of the diagnosis of meningococcal infection by means of agglutination of sensibilized latex particles with erythrocytes have been demonstrated . Polysterene carboxylated latex has been sensibilized by rabbit JgG to meningococcus of serogroup A . Dynamics of absorption of meningococcal polysaccharide on erythrocytes in vivo has been studied in mice.

Med Trop (Mars), 1990 Apr, 50(2), 227 - 9
{Epidemiological notes: meningococcal meningitis of serogroup X in Niamey (Niger)}; Etienne J et al.; From 19th February to 15th April 1990, 22 strains of meningococcus belonging to serogroup X have been identified by the Centre for Study and Research on meningitidis and Schistosomiases (CERMES) at Niamey (Niger) . Serogroup X has been confirmed by the Centre Collaborating WHO of Reference and Training for Meningococci (CCOMSRFM) at Marseille (France) . These strains have been isolated from cerebrospinal fluid of patients suffering from cerebrospinal meningitis and living in different neighbourhoods of Niamey . Apparition of cases of meningococcal meningitis with other serogroups than A implies identification of serogroup of meningococcus in intertropical Africa.

Microbiologica, 1990 Apr, 13(2), 109 - 13
Genomic fingerprints and phenotypic characteristics of strains of Neisseria meningitidis causing disease in Italy; Mastrantonio P et al.; Since 1984 a change in the epidemiological pattern of meningococcal disease in Italy has occurred with a predominance of Neisseria meningitidis of serogroup C (76%), serotype 2a and a high proportion of strains resistant to sulfonamides (71%) . To better understand the epidemiology of the group C N . meningitidis strains responsible for the disease over the last five years in Italy, we studied the DNA fingerprinting of 62 strains in combination with serotyping and sulfonamide susceptibility testing . The results show that the phenotypical features as well as the fingerprints of the strains studied were similar, suggesting the spread of a single clone in the patients studied . This is in agreement with the circulation of strains typical of epidemic situations, despite the decreasing incidence of the disease in Italy during the examined period.

Mikrobiyol Bul, 1990 Apr, 24(2), 111 - 9
{Meningococcal meningitis in adults}; Topcu S et al.; The clinical and laboratory findings, and the results of treatment of 16 Meningococcal meningitis cases, who were hospitalized, are investigated, and discussed with the literature . On application all of the patients had headache, meningeal irritation findings, and fever (% 75), nausea and vomiting (% 62.5), rash (% 56.25), unconsciousness (% 50), coma state (% 31.25), Herpes labialis (% 31.25), affecting of cranial nerves (% 12.5), arthritis (% 12.5), and carditis (% 6.25) . At the peripheric blood examinations, all had leucocytosis, and neutrophilia . In the direct examination of the cerebrospinal-fluid, in 15 patients gram negative diplococci were seen, and in 11 patients the microorganisms grew on culture . The patients were given Crystalized-Penicillin in doses of 20-30 million IU/day . In the two cases some complications, resistance, and allergy developed, so the treatment changed . Only a patient died, and in the other cases no relapse and sequel were seen.

Ned Tijdschr Geneeskd, 1990 Mar 24, 134(12), 609 - 13
{Meningococcal disease in the winter season 1988-1989}; Postema CA et al.; We describe the 304 cases of meningococcal disease notified from week 45 of 1988 and up to week 21 of 1989, and compare these data with those for 1966, the year of the last epidemic in The Netherlands . During the epidemic the interval between the first day of illness and the moment of reporting shortened.

Anesteziol Reanimatol, 1990 Mar-Apr, (2), 28 - 33
{Hemodynamics and rheologic properties of the blood in meningococcemia associated with meningitis and complicated by septic shock and intracranial hypertension}; Radzivil GG et al.; Central hemodynamic parameters characterizing cardiac contractility and peripheral resistive vascular tone, as well as blood aggregation ability, its structural and dynamic viscosity have been assessed by dynamic (disease duration up to 15 days) and complex studies in 28 patients with septic shock of meningococcal etiology accompanied by signs of meningitis . All the patients revealed signs of intracranial hypertension caused by the onset of acute hydrocephaly or brain edema . It has been demonstrated that on entry all the patients were characterized by the combination of low cardiac output syndrome and second degree high or low blood viscosity . In addition to endotoxemia, acute intracranial hypertension that enhances the afterload and blood viscosity abnormalities are involved in the development of hemodynamic disturbances . Over the whole observation period elevated intracranial pressure had a certain effect on central hemodynamics, changing according to the mechanism similar to that observed in Cushing's syndrome . In addition, central hemodynamics and blood viscosity are directly or indirectly (via affected CNS) influenced by Herpes infection developing on days 2 to 5 of the disease.

Public Health, 1990 Mar, 104(2), 99 - 102
Detection and prevalence of hearing loss in a cohort of children following serogroup B, meningococcal infection 1983-1987; Dawson JA et al.; A study of hearing loss in 50 surviving children aged 2 months to 17 years, hospitalised with serogroup beta meningococcal infection between 1983-1987, indicated that 35 (70%) had a hearing assessment . The majority were admitted under the care of the paediatricians . Older children tended not to have a follow-up hearing assessment . Impairment of hearing was found in 3, (8.6% of those tested, or 6% of the whole group) . Two similar studies in the early and late 1970s indicate comparable prevalence estimates . There is little indication that over the past 17 years the prevalence of hearing loss has declined.

Public Health, 1990 Mar, 104(2), 103 - 7
Trends in meningococcal disease in Italy in 1988; Stroffolini T et al.; Meningococcal disease in Italy decreased 15% in 1988 from the previous year (290 vs . 342 cases) . The decline was particularly evident in military cases (1.7/100,000 in 1988 vs . 5/100,000 in 1987) reflecting the full coverage of bivalent serogroup (A + C) meningococcal polysaccaride vaccine in army recruits, achieved since January 1988 . The highest proportion of cases was seen in people older than 25 years of age (25%) . Serogroup C constituted 60% of the isolates, while 19% belonged to serogroup B . The proportion of strains resistant to sulphonamides was 45%, while 15% were resistant to Minocycline and none to Rifampin . Out of the five military cases, only one (due to serogroup C) was attributable to the vaccine failure . A single coprimary case, but no secondary cases occurred among civilians . These findings are consistent with the trends reported in Italy in the previous years.

Intensive Care Nurs, 1990 Mar, 6(1), 17 - 24
Acute meningococcaemia: a case study; Fiorentini A; A 20-year-old female presented with sudden onset of abdominal pain, diarrhoea and vomiting progressing to fever, tachycardia and mild hypotension . Within 12 hours, a petechial rash appeared on the face and abdomen, spreading to the extremities . Laboratory findings confirmed the diagnosis of acute meningococcaemia . Clinical features of endotoxic shock, vasculitis and skin necrosis rapidly ensued . Aggressive treatment to control the septicaemia, disseminated intravascular coagulation and unstable cardiovascular state ultimately proved successful . Approximately 6 weeks later, amputation of some of the digits and extensive skin grafting were carried out in the Regional Burns Unit . However, serious psychological side effects gradually began to appear which required urgent psychiatric intervention . For an active young woman the challenge of coping with such a severe illness and coming to terms with the disability and disfigurement resulting from it was almost overwhelming . It was, perhaps, particularly hard because of the threat posed to her ambition to complete her nursing education and become a nurse . Little was found in the nursing literature on acute meningococcaemia . But this illness provides considerable challenges not only to those who suffer from it, but also to those who nurse them . A final brief review of published literature on acute meningococcaemia and the clinical manifestations and outcome of it is provided for those who wish to know more about it.

Rev Sanid Hig Publica (Madr), 1990 Mar-Apr, 64(3-4), 163 - 9
{Meningococcal meningitis in Spain (1878-1987) . VI . Evolution of the proteic subtypes within the serotypes 2 and 15 of Neisseria meningitidis during the epidemic wave}; Roman F et al.; We have serotyped 620 strains of Neisseria meningitidis, isolated from patients between 1978-1987 . These strains, belonging to serotypes 2 and 15, were the most prevalent ones detected during the last epidemic outbreak in Spain . These strains were analyzed by means of polyacrylamide gel electro-phoresis and monoclonal antibody coagglutination, to differentiate subtypes into type 15 and type 2 complex (2a, 2b and 2c types) . The proportion of type 2b strains is quite high in group B, and the proportion of subtypes P1.15 and P1.16 is very similar in the same serogroup . We compared the results with those obtained in other countries in our geographical area.

Zh Mikrobiol Epidemiol Immunobiol, 1990 Mar, (3), 61 - 5
{Immunochemical properties of a protective cross-reacting antigen of meningococci}; Gorlina MKh et al.; The study of protective cross-reacting antigenic preparations isolated from meningococci of groups A and C in the blot immunoassay has shown the presence of a group of proteins with a molecular weight ranging from 23 to 31 KD and common for 8 tested serological groups of meningococci, gonococci and 4 nonpathogenic Neisseria species . The possible role of these structures as common Neisseria antigen in the formation of natural resistance to meningococcal infection is discussed.

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