Eur J Epidemiol, 1990 Mar, 6(1), 80 - 3 Use of DNA fingerprinting in an epidemiologic study of outbreak-specific and non-specific strains of group C Neisseria meningitidis; Facinelli B et al.; DNA fingerprints of nine group C isolates of Neisseria meningitidis were obtained by digestion with three restriction endonucleases, BamHI, EcoRI, and HindIII . Identical restriction profiles were displayed by five strains isolated from two patients and three contacts during a localized outbreak of meningococcal disease in the area served by our laboratory . A slight difference, appreciable only in the fingerprints obtained with EcoRI, was observed between these isolates and a sixth one isolated from a clinical case occurring in the same area one year later . In contrast, three additional strains, recently isolated from patients in separate areas in Italy, gave restriction profiles differing strikingly from one another and from those produced by the strains isolated in our area. Afr J Med Med Sci, 1990 Mar, 19(1), 1 - 3 Disease in children due to serogroup W-135 Neisseria meningitidis; Joiner KT et al.; Two cases of meningococcal disease due to serogroup W-135 Neisseria meningitidis are presented . One died from fulminating meningococcaemia and the other had severe meningoencephalitis with acute septic arthritis . Serogroup W-135 N . meningitidis is pathogenic for man, and laboratories should attempt to identify and serotype the organism so that more data about the disease it causes can be obtained. Minerva Med, 1990 Mar, 81(3 Suppl), 49 - 51 {A case of meningococcal sepsis}; Bonzano L et al.; We describe a 7-years boy by with a meningococcal sepsis due to Neisseria Meningitidis, with very serious evolution of cutaneous necrosis, initial D.I.C . and heart failure . The clinical picture do not improve with antibiotic therapy (CAF-penicillin), but the association ceftriaxone + tobramycin results in rapid improvement . The cutaneous necrosis, especially evident on gluteus, arms and legs, were treated locally with AgNO3 and penicillin-solution . After 4 weeks of treatment, also this cutaneous involvement improved and now the boy is healthy, without residual signs neither systemic nor cutaneous. J Med Microbiol, 1990 Mar, 31(3), 195 - 201 Serotyping and subtyping of Neisseria meningitidis isolates by co-agglutination, dot-blotting and ELISA; Wedege E et al.; Typing of meningococci with a panel of serotype and subtype specific monoclonal antibodies (MAbs) was compared in co-agglutination, dot-blotting and ELISA tests . Twenty reference strains, 50 case isolates and 133 throat isolates from healthy carriers were studied . The typing results with dot-blotting and ELISA were identical, whereas co-agglutination gave different results for three case and 24 carrier strains . The distribution of serotypes and subtypes among the strains is reported . The combination of the subtypes P1.1 and P1.15 in a serotype 15 patient strain was observed . With one case strain and 15 carrier strains, neither serotype nor subtype could be determined . Non-typable and non-subtypable isolates were further characterised by sodium dodecyl sulphate-polyacrylamide gel electrophoresis . Co-agglutination is useful for typing small numbers of strains with a few MAbs, but less suitable for large-scale typing than the other two methods . Dot-blotting needs less expensive equipment, smaller volumes of antibodies and fewer manipulations than ELISA. Tidsskr Nor Laegeforen, 1990 Feb 20, 110(5), 614 - 7 {Clinical trials of the new Norwegian vaccine against diseases caused by Meningococcus B}; Bjune G et al.; Since 1974 Norway has experienced an epidemic of meningococcal disease . In October 1986 the National Institute of Public Health decided to develop and test out a vaccine against group B meningococci . This paper describes how the vaccine was tested through phase I and II trials, and how problems of safety and informed consent were handled . Two major protection trials are currently in progress . 130,000 secondary school students have volunteered for a study simulating the use of a vaccine in the long-term protection of an age group at risk . Military recruits are involved in a study where instant protection is important, as in a situation where the vaccine is used in the vicinity of an outbreak of the disease . 20,000 soldiers are included so far, and the study will ultimately include 70,000. Isr J Med Sci, 1990 Feb, 26(2), 90 - 2 Post-traumatic meningococcemia in a patient with deficiency of the C7 complement component; Molad Y et al.; A 20-year-old woman with C7 deficiency and fulminant meningococcemia that appeared after a blunt head trauma is described . This C7 deficiency was found in two of her siblings and should be suspected in patients presenting with neisserial infections. Can J Microbiol, 1990 Feb, 36(2), 117 - 22 Antibodies to meningococcal H.8 (Lip) antigen fail to show bactericidal activity; Bhattacharjee AK et al.; Purified H.8 (Lip) antigen was coupled to tresyl-activated Sepharose 4B and used in affinity columns to purify anti-Lip antibodies from convalescent patient sera and from immune rabbit sera . Affinity-purified anti-Lip antibodies isolated from two convalescent patient sera contained 1000 and 1280 ELISA units of antibody and included antibodies of IgG, IgA, and IgM isotypes . An anti-Lip mouse monoclonal ascites (2-1-CA2) had 28,400 ELISA units of antibody . Bactericidal assays were performed using three different case strains of Neisseria meningitidis group B, namely 44/76, 8532, and 8047 . Neither preparation of purified human anti-Lip antibodies had detectable bactericidal activity against strains 44/76 and 8532, but one of the two had a titer of 1:4 against strain 8047 . Anti-Lip antibodies that were purified from immune rabbit serum and contained 1600 ELISA units of anti-Lip antibodies also failed to show detectable bactericidal activity . The rabbits were immunized with purified Lip antigen and showed specific antibody levels of 2000-2200 units by ELISA, but even the unfractionated sera had little or no bactericidal activity against the test strains . The high titer mouse monoclonal ascites had no bactericidal activity against the test strains . The poor bactericidal activity associated with monoclonal and polyclonal antibodies to the Lip antigen suggest that in spite of other attractive properties it may not be useful as a meningococcal vaccine. Zhonghua Liu Xing Bing Xue Za Zhi, 1990 Feb, 11(1), 34 - 7 {Immune response and post inoculation reactions of simultaneous administration of hepatitis B vaccine with routine vaccine in children, III . Immune response and post inoculation reactions of simultaneous administration of hepatitis B vaccine and BCG, meningococcus group A polysaccharide vaccine}; Yuan C; The results of the immune response and post inoculation reactions of simultaneous administration of BCG, meningococcus group A polysaccharide vaccine and hepatitis B vaccine were reported . 360 newborn babies (1-3 days of age) were divided into five groups . The babies in group No . 1 were vaccinated with hepatitis B vaccine alone, babies in group No . 2 were vaccinated with BCG for scarification within 3 days after delivery and meningococcus group A polysaccharide vaccine in 6 months of age; babies in group No . 3 were vaccinated with hepatitis B vaccine, BCG for scarification and Meningococcus group A polysaccharide vaccine simultaneously, babies in group No . 4 were vaccinated with intradermal BCG and Meningococcus group A polysaccharide vaccine separately, babies in group No . 5 were vaccinated with hepatitis B vaccine, intradermal BCG and meningococcus group A polysaccharide vaccine simultaneously . The results of the immune response of the combination of hepatitis B vaccine with BCG, meningococcus group A polysaccharide vaccine were similarly to the immune response observed after immunization of each vaccine alone in children . The general post inoculation reactions of all vaccines were mild . There was no significant difference among all 5 groups . The data showed that children could be immunized with hepatitis B vaccine, BCG and meningococcus group A polysaccharide vaccine simultaneously. J Histochem Cytochem, 1990 Feb, 38(2), 209 - 15 Immunohistochemical localization of polysialic acid in tissue sections: differential binding to polynucleotides and DNA of a murine IgG and a human IgM monoclonal antibody; Husmann M et al.; For immunolocalization of alpha(2-8)-linked polysialic acid, which forms part of the neural cell adhesion molecule (N-CAM), two monoclonal antibodies, MAb735 and IgMNOV, were employed . Both antibodies have previously been shown to bind the extremely low immunogenic capsular polysaccharide of group B meningococci, which also consists of alpha(2-8) polysialic acid, but not to other, even closely related forms of polysialic acid . Despite the identical polysaccharide specificity of these two MAb, we observed marked differences of the staining pattern in tissue sections . We showed that these differences in immunostaining were due to the crossreactivity of IgMNOV with polynucleotides and DNA . MAb735, however, was shown to react exclusively with alpha(2-8) polysialic acid . Moreover, the specificity of MAb735 proved to be unique among eleven other MAb directed against various bacterial polysaccharides, as it was the only one unreactive with polynucleotides . Thus, MAb735, the only IgG type mouse monoclonal antibody to polysialic acid thus far reported, can be considered a specific probe for the unambiguous detection of alpha(2-8) polysialic acid in tissue sections, and should therefore help to further elucidate the role of polysialic acid in developmental processes. Thromb Res, 1990 Jan 15, 57(2), 271 - 8 Plasminogen activator inhibitor 1 and 2, alpha-2-antiplasmin, plasminogen, and endotoxin levels in systemic meningococcal disease; Brandtzaeg P et al.; We have studied the activation state of the fibrinolytic system in 39 patients with systemic meningococcal disease (SMD) . Patients defined as having fulminant septicemia (n = 13) with high (greater than 700 ng/L) levels of endotoxin (LPS) in plasma and severe coagulopathy, had significantly lower functional levels of plasminogen (P less than 0.05) and alpha-2-antiplasmin (P less than 0.01) and higher antigen levels of plasminogen activator inhibitor 1 (PAI-1) (P less than 0.01), and fibrin degradation products (FDP) (P less than 0.01), but not of PAI-2 (P greater than 0.1) as compared with less severely ill patients (meningitis and meningococcemia) (n = 25) . A positive correlation existed between the admission (maximum) levels of LPS and PAI-1 (r = 0.86, P less than 0.0001) . Decreasing admission levels of platelets were associated with increasing levels of PAI-1 (r = -0.55, P less than 0.001) . After initiation of treatment with antibiotics and fresh frozen plasma, the PAI-1 levels declined rapidly . PAI-1 levels greater than 360 micrograms/L on admission predicted the development of a severe septic shock combined with renal impairment correctly in 12 of 13 patients (92%) . None of 25 patients without multiple organ failure had PAI-1 levels greater than 260 micrograms/L . PAI-1 levels greater than 1850 micrograms/L were associated with 100% fatality . The results suggest that in the early phase of fulminant meningococcal septicemia an extensive plasmin generation occurs . On admission, however, high levels of PAI-1 seem to inhibit the plasmin generation, and thereby promote DIC. Sov Med, 1990, (6), 7 - 10 {Characteristics of blood circulation disorders in meningococcal meningoencephalitis}; Radzivil GG et al.; Studies of liquorologic, hemodynamic, electrophysiologic, and biochemical characteristics of the blood, carried out over the course of the disease in 110 patients with purulent meningoencephalitis of meningococcal etiology, complicated by development of high intracranial hypertension, have revealed a hypokinetic type of circulation, characterized by reduced heart performance and elevated afterload, in the majority of the examinees during the acute period of the disease . Among the causes contributing to the formation of the hypokinetic type are inflammatory and dystrophic changes in the myocardium, deterioration of the blood rheology (of the high blood viscosity syndrome type), and vasopressor effect of elevated intracranial pressure (Cushing's phenomenon) resultant from brain edema developing in the majority of patients . The findings evidence the leading role of intracranial pressure elevation in the origin of increased tone of resistive vessels and in the development of macro- and microcirculatory disorders in the acute phase of the disease. Nord Med, 1990, 105(6-7), 179 - 81 {Systemic meningococcal disease in the Norwegian Army}; Djupesland P et al.; An outline of aspects of meningococcal disease relevant to The Norwegian armed forces during the last years is given . Epidemiological observations are described as well as ongoing trials with the Norwegian serogroup B outer membrane complex vaccine . These trials are parallel to civilian trials in teenagers . In accordance with the new Norwegian civil guidelines for diagnosis and treatment of meningococcal disease stress is laid on early symptoms of the disease and early treatment (drawing of a blood culture and subsequent prompt parenteral penicillin therapy in the camp when probable meningococcal disease is the case and the estimated transportation time to hospital exceeds about 30 min). Respiration, 1990, 57(1), 62 - 4 Diffuse lymphangioma with intrathoracic involvement; Zuckerman E et al.; A case of a young girl with oligosymptomatic multiple cystic lesions of the chest is presented . The chest lesions were found on routine chest X-ray when she was admitted because of meningococcal meningitis . As the lesions increased in size, surgery was performed; the operative specimens were identified as lymphangioma . This is a rare disorder, which presents difficulties in diagnosis and treatment . Its benign nature is challenged by its tendency to recur and the need for repeated operations. Scand J Infect Dis, 1990, 22(2), 161 - 70 Features of a large epidemic of group A meningococcal meningitis in Khartoum, Sudan in 1988; Salih MA et al.; A large epidemic (February-August 1988) of group A sulphonamide resistant, clone III-1 meningococcal meningitis in Khartoum, Sudan is described . A total of 10,099 cases were admitted to treatment centers with 8,397 cases during March and April, corresponding to an annual incidence of 1,679/100,000 inhabitants during this period . The age profile showed a high morbidity in adults (31% of the cases greater than or equal to 20 years) . The male dominance was marked especially in the adult cases with a proportion of 3.2:1 . The epidemic started during the hot and dry season and declined when the clouds came, humidity rose, temperature fell and a mass vaccination campaign had been implemented together with other epidemic precautions . Vaccination with a combined group A/C polysaccharide vaccine had been given 4 weeks-1 year before hospitalization to 11% of the children, 80% of whom were greater than 18 months of age . The estimated case fatality rate was 6.3% . Since 47% of the cases came from periurban and rural areas, the actual mortality during the epidemic might have been higher when considering those who may have died before reaching any of the treatment centres . Fatal cases had a short history of acute illness and a septic condition . Septicaemia was rare and seen in only 3.7% of the cases, the rest had acute purulent meningitis . Hearing loss/impairment and hemiplegia was diagnosed in 2-3% of the cases . The epidemiology, based on detailed typing/subtyping and restriction enzyme patterns of meningococcal strains, was apparently associated with the Mecca outbreak in August 1987. Vrach Delo, 1990 Jan, (1), 109 - 12 {Clinical and echoencephalographic data in assessing the outcome of meningococcal meningoencephalitis}; Gebesh VV et al.; The authors made a clinical analysis of outcomes of meningococcal meningoencephalitis in 100 patients with consciousness disturbances . It was established that the outcome of the disease depended on the time of hospitalization and degree of disturbed consciousness . The dynamics of neurological symptoms and echoencephalography of brain edema is of importance in evaluation of the prognosis of meningoencephalitis. Scand J Infect Dis, 1990, 22(1), 31 - 6 Complement and immunoglobulin studies in 15 cases of chronic meningococcemia: properdin deficiency and hypoimmunoglobulinemia; Nielsen HE et al.; The purpose of this study was to investigate whether patients with chronic meningococcemia have abnormalities in their humoral immune system . The alternative and classical complement system, the levels of IgA, IgG and IgM, as well as IgG subclasses were studied in 15 individuals who had recovered from chronic meningococcemia . We found one individual with complete deficiency of properdin, a component of the alternative complement pathway . In the other patients, the complement system was normal . The mean plasma IgG concentration was significantly below normal in the patient group, while the mean values of IgA, IgM and the IgG subclasses were normal . Two individuals, however, had low IgG2 and IgG4 levels . We conclude that properdin deficiency and reduced plasma IgG levels may predispose to chronic meningococcal disease, but that the majority of patients with chronic meningococcemia have a normal humoral immune system. Acta Paediatr Scand, 1990 Jan, 79(1), 73 - 6 Fibronectin in meningococcal sepsis . Correlation with antithrombin III and protein C; Blanco A et al.; Plasma fibronectin was measured with Laurell's immunoelectroassay in 44 patients with meningococcal sepsis . The average value (15.0 +/- 7.9 mg/dl) was lower than that in normal children (27.4 +/- 8.7 mg/dl) (p less than 0.001) . Fibronectin in patients correlated positively with antithrombin III (AT-III) values (p less than 0.02), but not with protein C (0.05 less than p less than 0.1) . The decrease of fibronectin had no prognostic value . The fibronectin levels were lower in patients with disseminated intravascular coagulation (DIC+), than in those without DIC (DIC-) (p less than 0.02), but were lower in both groups than in a normal control group . A negative correlation between fibronectin and protein C was only present in DIC- patients (r: -0.773 = p less than 0.01) . Fibronectin varied independent of AT-III and protein C in DIC+ patients . The study was repeated in 11 patients 24 hours after admission when fibronectin had decreased in 7/11 cases (mean decrease: -2.7 +/- 8.7 mg/dl) . This variation correlated in a negative way with AT-III (r: -0.659 = p less than 0.05) . In meningococcal sepsis fibronectin decreases very early, even in DIC- patients and its relationship to AT-III and protein C is different, depending on the presence of DIC and on the stage of evolution of the disease. Bull World Health Organ, 1990, 68(5), 587 - 96 Surveillance and control of meningococcal meningitis epidemics in refugee populations; Moore PS et al.; Epidemics of communicable diseases pose a direct threat to refugee and internally displaced populations, and could lead to high mortality rates and a disruption of basic health care services . Several large refugee populations live in regions of high meningococcal disease endemicity and their camps are at risk for outbreaks of meningococcal meningitis . Surveillance in these camps allows early detection and control of impending outbreaks . Confirmation of meningococcal disease can be performed under field conditions using simple techniques, such as latex agglutination . Isolates should be obtained for serogroup confirmation and antibiotic sensitivity studies at reference laboratories . Serogroup information is used to determine the risk of widespread epidemic disease and the utility of available vaccines . During epidemics, treatment regimens should be standardized, preferably with an effective single-dose antibiotic . Mass vaccination campaigns should be initiated, the populations at high risk being targeted for vaccination as quickly as possible . When the risk of epidemic disease is deemed to be high, preemptive vaccination may be warranted . Daily surveillance using a simple case definition is essential during an epidemic to determine the effectiveness of control measures and to delineate high-risk groups for vaccination or chemoprophylaxis . Many of these recommendations can be applied also to other populations in developing countries. Scand J Infect Dis, 1990, 22(6), 755 - 6 Adrenal failure in fulminant meningococcal septicaemia: a clinical reality; McWhinney PH et al.; Current teaching is that adrenal failure is not a feature of meningococcal sepsis, and that cortisol levels are generally elevated . A case of fulminant meningococcal septicaemia in a 14-year-old boy is described . This patient had low/borderline cortisol levels, which normalised within some days. Scand J Infect Dis, 1990, 22(6), 673 - 9 Genetic aspects of complement component C8 in Norwegian meningococcal disease patients; Rogde S et al.; Sera from 85 consecutive systemic meningococcal disease patients and 203 matched control individuals were C8 typed . In the patient group, one C8B deficient individual was discovered; none in the control group . No case of C8A deficiency was encountered . The material was collected during a period of epidemic meningococcal disease in Norway, mainly due to group B organisms . C8A and C8B phenotype distributions were not significantly different in the two groups . This indicates that no particular C8 type (apart from deficiency) predisposes for meningococcal disease . Neither is there any evidence of over-representation of heterozygous deficiency among meningitis patients . The C8B deficient individual and his family were studied . Tests for haemolytic complement were normal in all members except for the proband . Electrophoretic C8 patterns seemed to be slightly weaker in the heterozygously C8B deficient individuals than in persons with 2 normal C8B genes . DNA from the family members were studied with regard to a restriction fragment length polymorphism (RFLP) for the C8B gene . All exhibited the same pattern, indicating that the C8B deficiency is not due to a major deletion in the C8B gene. Pediatr Pathol, 1990, 10(5), 769 - 84 Sudden, unexpected, natural death in childhood; Norman MG et al.; One thousand nine hundred and fifty four autopsies performed at British Columbia's Children's Hospital during a 7-year period were reviewed to determine the causes of sudden unexpected natural death in the age group from birth to 17 years . Of the 126 cases found, the largest group, 86 cases, was sudden infant death syndrome (SIDS) . Nine deaths were the result of infection: 4 cases of H . influenza meningitis, 2 cases of meningococcemia, 2 cases of acute epiglottitis, and 1 case of necrotizing tracheobronchitis . Epilepsy, ruptured AV malformations, and brain tumors combined to make up an equally large group of 9 cases . Cardiac lesions were the third largest group, 6 cases . The three groups that posed the most difficulty in assigning a cause of death were (a) the group that were like SIDS yet had other confounding features, (b) the group in which metabolic death was suspected but not proven, and (c) death in epilepsy. Nord Med . 1990;105(10):261, 265. {2 strategies in case of meningitis in Sweden}; Lindberg A; In contrast to the other Nordic countries Sweden has long had a favourable position as regards meningococcal disease . In the last 10 year period the annual incidence has been only about one case per 100,000 inhabitants . The treatment once the cause is confirmed is conventional and no different from that in the other Nordic countries but varies somewhat in the event of unknown etiology . Cortisone therapy also seems to be more frequent in treatment of meningitis . Two strategies for antibiotic prophylaxis are used in Sweden. Nord Med . 1990;105(10):260, 267. {Treatment of bacterial meningitis in Norway}; Brandtzaeg P; Infections with Group B meningococci have been a dominant infection problem in Norway in the last 15 years . The Norwegian recommendations as to treatment are reported in the article. Nord Med, 1990, 105(10), 252 - 4 {Purulent meningitis in Denmark}; Eriksen NH et al.; The epidemiology of meningococcal disease in Denmark has changed in recent years, with a rise in the number of cases in the 14-18 year age group . During the last decade 80 per cent of the meningococci belonged to Group B and 20 per cent to Group C . The treatment has followed the lines of the recommendations issued by the Rigshospitalet but some hospital departments have now chosen other preparations, as appears from the study presented in the article. Pediatriia, 1990, (3), 36 - 9 {Evaluation of the socio-economic effect of using immune anti- meningococcal plasma in pediatric practice}; Smirnova AI et al.; Analysis of the socioeconomic effectiveness of the use of immune antimeningococcal plasma in patients with the grave patterns of meningococcal infection has shown that introduction of the preparation into multimodality therapy results not only in a considerable medicosocial effect (reduction of lethality, lowering of the patients' stay at a hospital, a more rapid, as compared with the control group, removal of the symptoms of intoxication, elimination of hemodynamic disorders underlying the infectious toxic shock) but also in an appreciable economic effect. Intensive Care Med, 1990, 16(2), 121 - 4 Meningococcemia and purpura fulminans in adults: acute deficiencies of proteins C and S and early treatment with antithrombin III concentrates; Fourrier F et al.; It has been recently suggested that an acquired deficiency of proteins C and S could contribute to the pathogenesis of meningococcemic purpura fulminans (PF) in children . Our study was designed to measure the levels of antithrombin III (AT III), protein C, and protein S during adult PF and to determine the effects of an early infusion of high doses of AT III concentrates on clinical and biological alterations of PF . We studied five consecutive adult patients with meningococcemia (type B) and PF . The levels of AT III, protein C (antigen and activity), and protein S (total and free) were measured at admission and 24 h and 1 month later . The treatment included in each case: amoxycillin, dobutamine and high doses of AT III concentrates . All patients survived and were discharged without any sequelae . At admission, biological data were consistent with severely depressed protein C and protein S levels and moderately decreased AT III levels, without any discrepancy between protein C antigen and activity . After 24 h, AT III and protein S levels were within normal ranges, whereas protein C levels were still depressed . These data are consistent with the theory of a particular imbalance in the anticoagulant systems during meningococcemic PF, contrasting with the usual findings observed during septic disseminated intravascular coagulation . The possibility must be considered that high doses of one anticoagulant (AT III concentrates) could compensate for the acute decrease in the other (protein C system). Boll Ist Sieroter Milan, 1990, 69(1), 357 - 9 Meningococcal carriage and vaccination in army recruits in Italy; Di Martino M et al.; The effect of Neisseria meningitidis group A and C polysaccharide vaccine on nasopharyngeal carriage was studied in the training center for army medical officers in Florence . Nasopharyngeal swabs were cultured for N . meningitidis at the time of vaccination (one week after entry to service) and again seven weeks later in a follow-up cohort of 171 men . During the two surveys the overall carriage did not showed significant difference (respectively 16% and 12%); while the percentage of isolates belonging to the serogroup C showed a significant reduction from 6% to 0.6% (P less than 0.01) . No increased prevalence of meningococci belonging serogroups other than A or C was observed during the two surveys . The cumulative carriage was 20% . Out of the 35 carriers during the whole study period, only 5 (14%) belonged to the same serogroup . These findings show that meningococcal vaccine may inhibit the nasopharyngeal carriage of group specific meningococci in army recruits. Am J Nephrol, 1990, 10(5), 426 - 30 Persistent low C3 levels associated with meningococcal meningitis and membranoproliferative glomerulonephritis; Fernandez-Sola J et al.; Recurrent meningococcal meningitis is usually related to terminal complement factor deficiencies (C5-C8); however it is not frequent with isolated primary C3 deficiency . Similarly, membranoproliferative glomerulonephritis has been described in association with primary C3 deficiencies and the presence of C3 nephritic factor . We present a case of an 18-year-old woman with relapsing meningococcal meningitis in whom membranoproliferative glomerulonephritis and persistent low serum C3 levels were found . A detailed immunological study was performed, but no other abnormalities in the complement components were found . C3 Nef was also negative . Moreover, the familiar complement studies showed an asymptomatic C4 deficiency in her mother and borderline C3 levels in her sister . The presence of persistent low serum C3 levels in the absence of other immunological abnormalities suggests that this is the cause of the relapsing meningococcal infections and the glomerular disease of this patient . We suggest that a complement deficiency, including isolated C3 deficiency, should be ruled out in all cases of relapsing meningitis . Further, the possibility of glomerular disease should be carefully considered in these patients. Dermatologica, 1990, 181(3), 240 - 1 Chronic meningococcemia; Morier P; A case is reported of a 70-year-old woman with chronic meningococcemia . She had intermittent fever, purpuric papules disseminated on the trunk and limbs, headache, arthralgia and myalgia for 5 weeks . Treatment with ceftriaxone was rapidly successful. Scand J Infect Dis, 1990, 22(5), 547 - 51 Antibodies to meningococci in children with meningococcal disease; Flaegstad T et al.; Sera from 33 children with and 84 without meningococcal disease were examined for antimeningococcal IgG and IgM antibodies using an ELISA test . The meningococcal patients had a significantly higher prevalence of specific IgG antibodies (p = 0.0014), and also higher prevalence of IgM antibodies (p = 0.08; NS) than other children . These results indicate that the patients had been immunologically stimulated for some time before admission . The meningococcal patients who died had lower prevalence of specific IgM antibodies than the surviving patients, but the difference was not significant (p = 0.16) . A significant increase of or high level of antimeningococcal antibodies was found in 11/12 patients examined, the last one had high levels already at admission . This type of ELISA test should therefore be helpful in the diagnosis of meningococcal disease when blood or CSF cultures are negative. Ann Biol Clin (Paris), 1990, 48(4), 227 - 31 Sero-subtyping of group B, C, Y and A meningococci isolated in France in 1988; Riou JY et al.; During 1988, 291 strains of various serogroups (B, C, Y and A) isolated in France, have been sero and sub-typed . 74.5 p . cent of the strains were isolated from CSF and blood of patients; 25.4 p . cent were isolated from carriers . The "whole cell ELISA" procedure was used with monoclonal antibodies . The distribution of serotypes among serogroup B strains was as follows: serotype 1 (8.1 p . cent); 2a (19 p . cent); 2b (16.2 p . cent); 4 (20.2 p . cent); 14 (13.5 p . cent); 15 (23 p . cent): 40 p . cent remained non typable (NT) . Among serogroup C strains serotype 2a represented 74.5 p . cent of the strains . Serogroup A strains were only of the serotype 4 . Serogroup Y strains belonged to serotype 14 or were NT . Some associations between serotypes and subtypes were predominant such as B:2a:P1.2 or B:2b:P1.2 or B:4:P1.15 or B:15:P1.7 . Among serogroup C strains the antigenic pattern C:2a:P1.2 was most prevalent. Scand J Infect Dis, 1990, 22(2), 241 - 2 Serogroup A Neisseria meningitidis of clone III-1 present in western Norway as early as 1969-73; Hjetland R et al.; A clone of serogroup A Neisseria meningitidis recognized by multilocus enzyme electrophoresis and designated as clone III-1, has caused major epidemics of meningococcal disease in various parts of the world since the 1970s . In Norway, serogroup B meningococci have been responsible for an epidemic since the mid-1970s . We have studied a sample of 53 meningococci isolated from patients in western Norway prior to the serogroup B epidemic . 22/35 meningococcal isolates collected 1969-73 represented clone III-1, whereas this clone was not found in the 18 isolates from 1962-68 . It has been speculated that the epidemic of meningococcal disease in Finland caused by clone III-1 in 1973-75 had spread from an epidemic in USSR that began in 1969 . Our findings demonstrate, however, that the clone III-1 was present in Scandinavia in 1969. Scand J Infect Dis, 1990, 22(2), 171 - 4 Characteristics of serogroup A Neisseria meningitidis responsible for an epidemic in Ethiopia, 1988-89; Haimanot RT et al.; In September 1988, an epidemic of meningococcal disease started in Ethiopia . 21 Neisseria meningitidis isolates recovered from patients in Addis Ababa and towns 200 km south of the capital were characterized by serogrouping, serotyping, testing of susceptibility to antibiotics, restriction endonuclease fingerprinting, and multilocus enzyme electrophoresis . The 21 isolates were essentially homogeneous for all properties tested and belonged to clone III-1 of serogroup A N . meningitidis, which was also responsible for the epidemics in Saudi Arabia in 1987 and in Sudan and Chad in 1988. Indian J Med Res, 1990 Jan, 91, 27 - 32 Clinical, histopathologic & immunologic features of cutaneous lesions in acute meningococcaemia; Ramesh V et al.; Fifty children with culture proven acute meningococcaemia were studied during the winter outbreak of the disease in 1986-87 . Purpuric lesions were seen in 60 per cent, erythematous papules in 32 per cent, faint pink macules in 28 per cent, conjunctival petechiae in 10 per cent and herpes labialis in 20 per cent . Histopathology of skin lesions showed that the primary damage was to the dermal vessels, the extent of damage depending on the type of skin involvement . Diplococci in Gram's stained sections were seen frequently in purpuric as compared to the other skin lesions . They were located in degenerating neutrophils, endothelial cells, fibrin clots or freely in the vascular lumen . Electron microscopic study showed vascular changes accompanied by a perivascular phagocytic response . Both light and electronmicroscopy indicated the involvement of the coagulative mechanism in the pathogenesis of meningococcaemia . However, clinical parameters of clotting were often within normal limits . In the case of a child (who died eventually), a low platelet count and prolonged coagulation indices were observed . Sera from some of the children were tested for the presence of antibodies against meningococci by indirect immunofluorescence . Antibodies were detected in the sera and they may have a role in regulating the severity and course of the illness . The significance of immunoglobulin deposits in the skin lesions is not clear. J Immunoassay, 1990, 11(1), 31 - 47 Characterization of antibody labelled colloidal gold particles and their applicability in a sol particle immuno assay (SPIA); Martin JM et al.; This study describes the characterization of antibody labelled colloidal gold particles and their applicability in a sol particle immuno assay (SPIA) to quantify murine monoclonal antibodies of all IgG isotypes . Two physical methods (transmission electron microscopy (TEM) and dynamic light scattering (DLS}, were used to obtain information about particle size and morphology of the gold sols, but only with DLS antibody labelling could be detected . In addition, electrophoretic methods like agarose electrophoresis and sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) showed also that antibody labelling was successful . The biological activity of the antibody gold conjugates was determined by using them in a SPIA and as an electrondense marker in an immunogold labelling procedure to visualize meningococcal surface exposed outer membrane proteins labelled with monoclonal antibodies . The SPIA was applicable to determine murine monoclonal antibodies of all IgG isotypes with a sensitivity of 20-80 ng/ml and a coefficient of variation of 6.7 +/- 2.2%. Scand J Infect Dis Suppl, 1990, 74, 262 - 9 Efficacy and safety of antibiotic treatment in relation to treatment time; Norrby SR; Decisions on treatment times with antibiotics are often arbitrary and based on empirical decisions or clinical trials which are too small to exclude even considerable differences between two study groups . Single-dose treatment of uncomplicated cystitis in women has been advocated by many but a careful analysis of available information clearly shows that a single-dose has so far always been inferior to 3-day or greater than 5-day treatment . With trimethoprim-sulphonamide combinations, no further efficacy is gained by increasing the treatment time in uncomplicated cystitis above three days while frequency of side effects increases drastically with extended treatment . In contrast, treatment with beta-lactams, for less than five days seems to result in unacceptable failure rates . In pyelonephritis there are few studies of the efficacy of antibiotic treatment for less than ten days . A comparison of two and six weeks' treatment showed no advantages with the extended time . There has also been a tendency towards reduced treatment times in upper respiratory tract infections such as streptococcal pharyngotonsillitis . However, two studies comparing 10-day treatment to 7-day and 5-day treatments, respectively, have clearly shown that the shorter treatment times give much higher rates of both clinical and bacteriological relapse . In more severe infections such as meningitis, no studies comparing treatment times have been carried out . It seems possible to use treatment for five days or less in meningococcal meningitis while other pathogens should be treated for ten days or longer . In endocarditis, the treatment time must vary with causative pathogens and can only rarely be shorter than four weeks.(ABSTRACT TRUNCATED AT 250 WORDS) Ter Arkh, 1990, 62(11), 25 - 7 {The enzymatic antioxidant system of the thrombocytes in meningococcal infection}; Iurkiv VA et al.; A study was made of the time-course of changes in the activity of the enzymic antioxidant system of blood platelets from patients with meningococcemia and meningitis (mixed form) of medium gravity . As a result a steady unbalance in the redox system of glutathione was established: a decrease of glutathione reductase activity and rise of the activity of glutathione peroxidases to hydrogen peroxide and tertiary butyl hydroperoxide until the clinical recovery . The patients with meningococcal meningitis and with the mixed form of medium gravity manifested impairment of the interrelations between superoxide dismutase and glutathione peroxidase to hydrogen peroxide, with that impairment being eliminated by the end of the disease . Potential mechanisms by which the enzymic antioxidant system is impaired in meningococcal infection are discussed. Ter Arkh, 1990, 62(11), 22 - 5 {The functional characteristics of the enzymatic antioxidant system in the erythrocytes and neutrophils of the blood of patients with generalized forms of meningococcal infection}; Prasnikova GI et al.; Patients with meningococcal infection, meningitis and with a mixed form of the disease were demonstrated to have unbalance in the redox system of glutathione during the all disease periods till the clinical recovery . Activation of glutathione peroxidases to hydrogen peroxide and tertiary butyl hydroperoxide in erythrocytes was coupled, during the whole disease, with unbalance of the time-course of changes in the interrelated enzymes--superoxide dismutase and glutathione peroxidase to hydrogen peroxide, while in neutrophils, the balance of those enzymes remained unimpaired . Glutathione transferase activity appeared reduced both in erythrocytes and neutrophils . Potential mechanisms by which the redox system of glutathione and superoxide dismutase may be deranged in meningococcal infection are under discussion. Bull Soc Pathol Exot, 1990, 83(5), 642 - 8 {Reliability of the diagnosis of cerebrospinal meningitis during an epidemic . The epidemic in Chad in 1988}; Spiegel A et al.; The authors analysed the positive predictive value (PPV) of the clinical diagnosis during an epidemic of meningococcal meningitidis in Africa . This PPV was globally 73.3 +/- 11.2% . This PPV was fluctuating according to the standards of the diagnosis . Typical clinical meningitic syndrome without spinal picture: 85.7 +/- 10.3%, Non typical syndrome and macroscopical aspect of cerebrospinal fluid: 62.5 +/- 16.4%. Zh Nevropatol Psikhiatr Im S S Korsakova, 1990, 90(11), 50 - 5 {Acute rise of intracranial pressure--one of the causes of disorders of systemic circulation in meningococcal lesions of the central nervous system}; Radzivil GG et al.; Tetrapolar chest rheography was used to study the central hemodynamics in 110 patients with meningococcal meningitides . Of these, in 86 patients, meningitis was combined with coccemia . The hyperkinetic type prevailed with a simultaneous decrease of the rate of the normo- and hyperkinetic types as compared with the distribution of the circulation types in healthy persons . It has been shown that the main cause of the development of the hypokinetic type of circulation manifesting itself in the rise of the total peripheral resistance and lowering of myocardial contractility lies in acute rise of intracranial pressure at the expense of the development of acute hydrocephalus and/or brain edema . Favouring intracranial pressure reduction decompression of the subarachnoidal space by lumbar puncture brings about a decline of the peripheral resistance, i.e . of afterload, and a rise of myocardial contractility . Detoxication and therapy of brain edema with the aid of the hypervolemic version of forced diuresis performed by means of intravenous injection of hyperosmotic solutions (rheopolyglucin, concentrated solutions of albumin, glucose) at a rate of 100 ml within 30 to 40 minutes promote the growth of intracranial pressure, elevation of the peripheral resistance and reduction of myocardial contractility. Lab Delo, 1990, (11), 70 - 2 {Preservation of microorganisms by deep freezing}; Koroleva IS; Meningococci, pneumococci, and hemophilic bacilli may be stored at -70 degrees C . Only half (54.4 percent) of Meningococcal cultures were viable after 11 months storage, 41.6 percent retained their serologic properties . Conditions for stable long storage of meningococci at -70 degrees C are to be searched for . Pneumococci retained their initial parameters for 8 months, this permitting recommendation of such storage for these bacteria . No data on the possibility of hemophilic bacilli storage is available yet. Ann Trop Paediatr, 1990, 10(3), 231 - 8 Clinical features and complications of epidemic group A meningococcal disease in Sudanese children; Salih MA et al.; The clinical presentation and laboratory features in relation to short-term outcome in 118 prospectively studied Sudanese children who were admitted with meningococcal (MC) meningitis and/or septicaemia during the 1988 group A MC epidemic in Greater Khartoum are described . Their ages ranged from 25 days to 15 years (mean: 78 months) and 42% were less than 5 years old . The male:female ratio was 1.6:1 . Forty (34%) came from one of the peri-urban shanty towns encircling Greater Khartoum . A history of MC immunization (A and C vaccine) was obtained in 22%, but only five children (4.8%) had the vaccine between 4 weeks and 1 year before their illness . The commonest symptoms on admission were vomiting, neck rigidity and diarrhoea . Convulsions were significantly more frequent in children under 5 years old (p = 0.0005) . Fifty-six (47%) had evidence of malnutrition . In descending order, fever, neck stiffness and Kernig's sign were the most commonly observed signs, the latter two being significantly more often detected in children older than 1 year . Twenty-four patients 20%) had disturbed consciousness . The case fatality rate was 6.3% and this was significantly higher in those presenting with meningococcal septicaemia (p = 0.0006) . Other significant associations with mortality were short duration (less than 1 day) of symptoms (p = 0.0006) and clinical shock detected on admission p = 0.003) . Transient complications were infrequent and permanent neurological sequelae were confined to bilateral profound sensorineural hearing loss in three children (2.9%) and hemiplegia in two 1.9%.(ABSTRACT TRUNCATED AT 250 WORDS) Clin Exp Immunol, 1989 Dec, 78(3), 402 - 5 Immune status and response to immunization with polysaccharide vaccines of a healthy, congenitally asplenic woman; McElroy PJ et al.; We describe the immune status of a congenitally asplenic, otherwise healthy and anatomically normal 30-year-old woman . As in surgically asplenic subjects, she had Howell-Jolly bodies in a blood smear, increased B lymphocyte and decreased T helper and suppressor lymphocyte percentages, and a slightly lower than average T helper/suppressor ratio . Because of the increased risk of infection with capsulate bacteria in asplenic patients, the subject was immunized with Pneumovax and meningococcal vaccine and her serum antibody responses were investigated . She was found to have subnormal IgG antibody titres which did not increase on immunization, although the subclass distribution of anti-pneumococcal antibody was normal with IgG2 predominating . IgM antibody titres were higher than in a pool of normal adult human sera, while IgA levels increased substantially as in normal subjects. Pediatrics, 1989 Dec, 84(6), 1051 - 5 Fever and petechiae in children; Baker RC et al.; A prospective study of patients with fever and petechiae was performed . Of 190 patients enrolled in the 1-year study, 13 (7%) had meningococcal disease . The most common bacterial association was Streptococcus pyogenes (19 patients) . Viral infections were documented in 28 patients . Patients with invasive bacterial disease (group I) appeared more sick, were more likely to have signs of meningeal irritation, and were more likely to have petechiae on the lower extremities than those with less serious, nonbacteremic disease (group II) . No patient in group I had petechiae only above the nipple line . Patients in group I had a significantly higher peripheral white blood cell count and absolute band form count . Although no laboratory test or physical finding was sufficiently sensitive to detect all patients with serious disease, the patient with abnormal cerebrospinal fluid, elevated white blood cell count, or elevated absolute band form count was at increased risk for invasive, bacterial disease . Conversely, the risk of serious disease was small if all of these values were in the normal range in the nonill-appearing child or if sore throat and clinical pharyngitis were present in the patient older than 3 years of age. J Exp Med, 1989 Dec 1, 170(6), 1859 - 67 Local production of tumor necrosis factor alpha, interleukin 1, and interleukin 6 in meningococcal meningitis . Relation to the inflammatory response; Waage A et al.; We examined the cerebrospinal fluid (CF) taken on admission from 60 patients with infections caused by Neisseria meningitidis for presence of TNF-alpha, IL-1, and IL-6 . TNF-alpha was detected in CF in 55 and 19% (p = 0.03), IL-1 in 50 and 15% (p = 0.05), and IL-6 in 98 and 100% of patients with meningitis and septic shock/bacteremia, respectively . The median IL-6 concentration in CF in patients with meningitis was 154 ng/ml, and in patients with septic shock/bacteremia it was 42 ng/ml (p = 0.001) . The level of LPS in CF correlated with the level of TNF-alpha (r = 0.91, p less than 0.001), but not with the level of IL-1 and IL-6 . CF levels of TNF-alpha, IL-1, and IL-6 correlated with each other (r = 0.34-0.54, p less than 0.01), with the protein concentration (r = 0.34-0.62, p less than 0.01) and inversely with the CF/blood glucose ratio (r = -0.34 to -0.67, p less than 0.01) . Only the Il-6 level correlated with the leukocyte count (r = 0.37, p less than 0.01) . In rabbits TNF-alpha, IL-1, and IL-6 activities sequentially appeared in CF within 3 h of injection of meningococcal LPS or viable meningococci, whereas the main infiltration of granulocytes started after 4 h . TNF-alpha was detected in serum at concentrations less than 1/100 of those in CF after administration of LPS into the subarachnoid space, and conversely, TNF-alpha was detected in CF at concentrations 1/100 of those in serum after intravenous injection of LPS . The results demonstrate that TNF-alpha, IL-1, and IL-6 are sequentially produced in the initial phase of the local inflammatory response caused by meningococci, and that the subarachnoid space and systemic circulation are separate compartments with respect to production of TNF-alpha, IL-1, and IL-6. Scand J Immunol, 1989 Dec, 30(6), 711 - 8 Hereditary, complete deficiency of complement factor H associated with recurrent meningococcal disease; Nielsen HE et al.; Complement factor H (beta-1H globulin) is an important regulatory protein which inhibits the spontaneous complement activation via the alternative pathway . We describe a 15-year-old girl without any detectable factor H in plasma . She has had two episodes of meningococcal disease, but is otherwise completely healthy . Secondary to the factor-H deficiency, the levels of factor B, properdin, C3, and C5-C9 were strongly reduced due to spontaneous in vivo activation of the alternative complement pathway . Plasma C3dg was strongly elevated in spite of the factor-H deficiency; apparently erythrocyte CR1 substitutes for factor H in C3 degradation . Neither C3 nor complement lesions were demonstrable on her erythrocytes which did, however, show increased, spontaneous haemolysis in vitro in citrate plasma, but not in serum . The patient is a single child and her parents, who are unrelated and healthy, had half-normal levels of factor H . This reduction of factor H is sufficient to cause increased, spontaneous activation of the alternative pathway. Zh Mikrobiol Epidemiol Immunobiol, 1989 Dec, (12), 36 - 40 {The epidemiological characteristics of meningococcal infection in the USSR}; Deviatkin NP et al.; The epidemiological analysis of morbidity in meningococcal infection in the USSR in the period of 1969-1987 showed that the second rise of the morbidity level occurred in 1984 and was followed by its decrease in most of the regions of the USSR . This study also revealed that the characteristic feature of the second rise of morbidity in meningococcal infection was a considerable involvement of young children (aged up to 3 years), as well as the increased etiological role of group B meningococci in cases of meningococcal infection and the circulation of these microorganisms among the population . Besides, the preservation of the etiological importance of group A meningococci in many regions of the USSR, especially among adults, was noted . In this connection, the use of Soviet group A meningococcal polysaccharide vaccine on epidemiological indications was considered to be epidemiologically substantiated. J Antimicrob Chemother, 1989 Dec, 24(6), 875 - 9 Conjugal transfer of gonococcal beta-lactamase and conjugative plasmids to Neisseria meningitidis; Brett MS; The filter mating of a gonococcal isolate, carrying the 3.2 Md beta-lactamase and 24.5 Md conjugative plasmids with a plasmid-free strain of Neisseria meningitidis, resulted in the transfer of both plasmids to the meningococcus . Transconjugants were able to maintain both plasmids and transfer the 3.2 Md plasmid to another meningococcal strain in a subsequent filter mating. J Clin Microbiol, 1989 Dec, 27(12), 2851 - 2 Maltose-negative Neisseria meningitidis isolated from a case of male urethritis; Phillips EA et al.; A maltose-negative strain of Neisseria meningitidis isolated from a male patient with urethritis was initially identified as a gonococcus on the basis of carbohydrate utilization tests . Additional investigations initiated because of atypical colony morphology and a negative superoxol reaction showed the isolate to be a meningococcus with defective maltose-phosphorylating capacity. J Gen Microbiol, 1989 Dec, 135 ( Pt 12), 3239 - 51 Identification of epitopes recognized by monoclonal antibodies SM1 and SM2 which react with all pili of Neisseria gonorrhoeae but which differentiate between two structural classes of pili expressed by Neisseria meningitidis and the distribution of their encoding sequences in the genomes of Neisseria spp; Virji M et al.; The pili expressed by all isolates of Neisseria gonorrhoeae react with two monoclonal antibodies, SM1 and SM2 . In contrast, although many isolates of Neisseria meningitidis also express pili (class I) which react with antibodies SM1 and SM2, a proportion express pili (class II) which fail to react . In order to define the epitopes recognized by these antibodies, a series of overlapping peptides corresponding to the amino acid sequence of conserved regions of gonococcal pili have been synthesized . The minimum epitope recognized by antibody SM1 was found to comprise a linear peptide EYYLN, corresponding to residues 49-53 of mature pilin . In contrast, antibody SM2 reacted with a number of peptides from around the cysteine residue (Cys 1) at position 120, suggesting that an extended region may contribute to a conformational epitope recognized by this antibody in the native protein . The identification of the two epitopes defines structural differences between the classes of pili expressed by meningococci . In order to determine the distribution of pilin gene sequences in Neisseria we used as hybridization probes an oligonucleotide (PS1) with the sequence 5'-GAGTATTACCTGAATCA-3' which spans the coding region for the SM1 epitope, and a fragment of the 3' end of the gonococcal pilE gene which contains conserved sequences flanking the two Cys codons and encodes the SM2 epitope . All strains of N . gonorrhoeae and N . meningitidis tested, regardless of piliation phenotype, harboured DNA sequences homologous to those encoding the carboxy-terminus of meningococcal class I pilin . Furthermore, all gonococci and all meningococci producing class I pili hybridized with oligonucleotide probe PS1 . Non-reverting non-piliated derivatives of previously class I pilus-producing strains showed reduced hybridization signals with this probe, but nevertheless retained sequences homologous to the coding sequence for the SM1 epitope . However, meningococci producing class II pili could be divided into two groups on the basis of their reaction with the PS1 probe: half the strains tested failed to react, which is consistent with our previous analysis of silent class I pilin sequences; the remainder reacted (relatively weakly) with the probe, suggesting that the silent pil sequences in these strains extend further towards the 5' end of the pilin gene than in strains studied previously . Some strains of Neisseria lactamica reacted weakly with both types of probe but failed to produce SM1-reactive pili . In contrast, isolates of Neisseria flava, Neisseria pharyngis, Neisseria sicca and a series of unrelated bacteria failed to react with both SM1 antibody and the DNA probes . This confirms that possession of 'gonococcal' pilin sequences is limited to the pathogenic neisseriae. AAOHN J, 1989 Nov, 37(11), 459 - 64 An employee health service in Saudi Arabia; Boyles C et al.; Health services for employees of this 500-bed tertiary care hospital include programs normally available to employees at hospitals in the United States . These programs include primary care, health promotion, health surveillance, and pre-employment health screening . The most pervasive influence on the health care provided is Islam . Saudi Arabia is a conservative Muslim country and all health care activities must be accomplished within the religious and cultural norms of the country . Communicable diseases endemic to this part of the world are of special concern in employee health . Special programs are in place for the prevention and control of tuberculosis, hepatitis B, brucellosis, ophthalmic chlamydia, malaria, and meningococcal disease. Clin Pediatr (Phila), 1989 Nov, 28(11), 529 - 32 Sudden-onset deafness . Serodiagnosis of recent meningococcal infection; Kline MW et al.; An 8.5-year-old boy was evaluated 3 weeks after the occurrence of a febrile illness associated with sudden-onset deafness . An extensive diagnostic evaluation was largely unrewarding . However, unusual epidemiologic features of the case and cerebrospinal fluid abnormalities suggested meningococcal meningitis as the probable etiology . Serologic studies confirmed recent meningococcal infection . The potential etiologies of sudden acquired deafness are diverse, but a thorough evaluation is warranted and may be rewarding, even if it is initiated weeks after onset of deafness. Rev Clin Esp, 1989 Nov, 185(7), 359 - 61 {Arthritis and purulent pericarditis as presenting form of sepsis caused by serogroup C meningococcus}; Martin-Juan JJ et al.; Meningococcal sepsis is usually a severe disease with very varied clinical manifestations . In our surrounding the most frequently appearing Neisseria meningitidis belongs to serogroup B, and only 10.2% belongs to group C . Both arthritis and exudative pericarditis are described as late, independent complications of N . Meningitidis C infections . The coexistence of both arthritis and suppurative pericarditis caused by this organism is extremely rare . A case of sepsis due to serogroup C N . Meningitidis in a patient who developed a right shoulder arthritis followed by septic shock and purulent pericarditis is presented . The characteristics of arthritis and pericarditis as complications of the acute meningococcal infection are analyzed, emphasizing the rareness of the coappearance of both as a form of clinical manifestation, as well as the purulent characteristic in order to keep them in mind and facilitate a prompt diagnosis and appropriate treatment. J Exp Med, 1989 Nov 1, 170(5), 1727 - 36 Colony morphology of piliated Neisseria meningitidis; Blake MS et al.; An association between piliation and colony morphology has not been observed for the meningococcus . We have found that growth of meningococci overnight at 30 degrees C in a candle extinction jar allows observation of distinct colonial phenotypes correlated to the presence or absence of piliation and the expression of opacity-associated proteins . These phenotypes are similar to those observed in gonococci grown overnight at 37 degrees C. Proc Natl Acad Sci U S A, 1989 Nov, 86(22), 8988 - 92 Recruitment of a penicillin-binding protein gene from Neisseria flavescens during the emergence of penicillin resistance in Neisseria meningitidis; Spratt BG et al.; Non-beta-lactamase-producing, penicillin-resistant strains of Neisseria meningitidis produce altered forms of penicillin-binding protein 2 that have decreased affinity for penicillin . The sequence of the penicillin-binding protein 2 gene (penA) from a penicillin-resistant strain of N . meningitidis was compared to the sequence of the same gene from penicillin-sensitive strains and from penicillin-sensitive and penicillin-resistant strains of Neisseria gonorrhoeae . The penA genes from penicillin-sensitive strains of N . gonorrhoeae and N . meningitidis were 98% identical . The gene from the penicillin-resistant strain of N . meningitidis consisted of regions that were almost identical to the corresponding regions in the penicillin-sensitive strains (less than 0.2% divergence) and two regions that were very different from them (approximately 22% divergence) . The two blocks of altered sequence have arisen by the replacement of meningococcal sequences with the corresponding regions from the penA gene of Neisseria flavescens and result in an altered form of penicillin-binding protein 2 that contains 44 amino acid substitutions and 1 amino acid insertion compared to penicillin-binding protein 2 of penicillin-sensitive strains of N . meningitidis . A similar introduction of part of the penA gene of N . flavescens, or a very similar commensal Neisseria species, appears to have occurred independently during the development of altered penA genes in non-beta-lactamase-producing penicillin-resistant strains of N . gonorrhoeae. Ann Ig, 1989 Nov-Dec, 1(6), 1293 - 8 {Tetravalent anti-meningococcal vaccine: serologic and clinical evaluation}; Vescia N et al.; Meningococcal disease is the only bacterial meningitis able to cause an epidemic and the mortality due to this disease is all but negligible; therefore the active immunization induced by a vaccine that includes a large portion of Neisseria meningitidis serogroups responsible for the immunization of subjects at risk . Tetravalent vaccine containing polysaccharides of the serogroups A, C, Y, W135 has given good results both for tolerability and immune response . Considering the epidemic situation in Italy, this vaccine could be an excellent strategy "to behead" possible epidemics and/or hyperendemics due to a known serogroups. Ugeskr Laeger, 1989 Oct 23, 151(43), 2814 - 5 {Reversible hearing impairment after meningococcal meningitis}; Hald J; A case of partial and fluctuating cochlear hearing loss persisting one year after meningococcal meningitis is presented . Repeated audiometry after the recovery from the disease is recommended in all patients. Clin Podiatr Med Surg, 1989 Oct, 6(4), 707 - 43 Sensory and motor deficits of central nervous system origin; Aravabhumi S et al.; The sensory and motor deficits of the CNS are varied, depending on the etiologic factors and the structures involved . Nevertheless, the clinical picture is predictable, provided one has an adequate knowledge of the neuroanatomy and the functions of the different fiber tracts, nuclei, and other specific regions of the brain and spinal cord . The purpose of this section is to provide an overall view of the sensory and motor deficits of the CNS, which will enable the clinician to treat these patients in a more objective and effective manner . Etiologically, the diseases affecting the CNS can be grouped under the following categories: congenital, traumatic, inflammatory, neoplastic, and degenerative . Congenital conditions usually manifest in infancy and childhood . Examples are hydrocephalus, spina bifida, and Arnold-Chiari malformation . There are a host of other conditions, but the discussion in this article is confined to the more common entities . Traumatic conditions such as cerebral concussion, contusion, laceration, hematomas--extradural, subdural, or intracerebral--and spinal cord injuries can occur in any age group, though their incidence is higher during the more active period of life (20 to 35 years) . Automobile accidents are by far the most common etiologic factor for the traumatic lesions . Others, such as falls, gunshot and stab wounds, and so forth account for the remainder . Among the inflammatory conditions, three conditions are important: brain abscess, meningitis, and transverse myelitis . Though brain abscess develops by direct extension from an adjacent focus of infection, often it forms as a result of metastatic infection, chiefly from lung abscess or bronchoectasis . It behaves more like an intracranial space occupying lesion . Of the various types of meningitis, meningococcal meningitis is the commonest . Transverse myelitis may be caused by viruses or bacteria . The clinical picture resembles that of spinal cord injury . Neoplasms of the brain and spinal cord present a wide and varied spectrum . They may be benign or malignant . Meningioma and neurofibroma are essentially benign lesions . Malignant tumors can be primary or secondary . Gliomas and specifically astrocytomas are the commonest primary malignant tumors . The commonest sites of metastatic tumors are lung, breast, kidney, and gastrointestinal tract . The clinical picture will depend on the location of the tumor and the structures pressed upon or infiltrated . Any age group can be affected . Many of the malignant tumors are slowly and relentlessly progressive . Complete surgical extirpation where possible, followed by radiation therapy, is the treatment of choice . Chemotherapy has not been of much benefit.(ABSTRACT TRUNCATED AT 400 WORDS) Med Trop (Mars), 1989 Oct-Dec, 49(4), 357 - 63 {Meningococcosis in Tunisia . Apropos of 80 cases}; Pousse H et al.; Meningococcosis are nowadays an health problem because their incidence rate (38 cases/100,000 people in 1986 in Mahdia region) and a high death rate (40%) due to fulminating forms . At the occasion of a prospective study during the first six months of 1987, the authors report the emergence of C serogroup (21%), the smallness of A serogroup (6.50%) and the predominance of B serogroup (68%) . Improving level of living, good prophylaxy based on spiramycin, development of use of meningococcal vaccine are advisable means to control epidemic outbreaks. Pathol Biol (Paris), 1989 Oct, 37(8), 901 - 7 {Neisseria meningitidis: serogroup Y . Apropos of 38 cases}; Le Bastard D et al.; Thirty-eight cases of infections due to Neisseria meningitidis serogroup Y have been studied . They correspond to the strains sent to the Laboratory (Centre National de Reference since 1987) . Their repartition was: meningitidis 9 cases, purpura fulminans (6), septicaemia (5), respiratory syndroms (11), asymptomatic carriage (4), various (3) . Patients were 4 months to 86 years old . Mortality was 13.2% . One third or meningitis or meningococcemia happened in correlation with complement deficiency or splenectomy . In most of cases bacterial diagnosis was made by general laboratories but only in two cases over 38 the serogrouping Y was made. Lancet, 1989 Sep 23, 2(8665), 723 - 5 Effect of smoking on meningococcal carriage; Stuart JM et al.; A case-control study was done to examine whether certain environmental or medical factors were associated with meningococcal carriage . Questionnaires were posted to 138 meningococcal carriers and their controls, and to 52 carriers of Neisseria lactamica and their controls . Carriers were matched to controls by age, sex, and area of residence . The overall response rate was 89% . There were no differences in environmental or medical factors between N lactamica carriers and their controls, nor in household crowding, housing conditions, frequency of physical exercise, or upper respiratory disorders between meningococcal carriers and their controls . Active smoking and the presence of other smokers in the household were independently associated with meningococcal carriage; the risk of carriage increased significantly with heavier smoking. CMAJ, 1989 Sep 15, 141(6), 567 - 9 Meningococcal disease in Canada: surveillance summary to 1987; Varughese PV; Meningococcal disease continues to occur in most parts of Canada at endemic levels, with minor fluctuations . The incidence in general has changed very little over the past three decades . It is primarily a childhood infection, occurring most commonly among infants less than 1 year of age . In 1987 the risk of infection among infants in that age group was 4 times and among those aged 1 to 4 years 2.5 times that of the general population . The most susceptible appear to be infants about 3 months of age . The annual CFRs had exceeded 50% before the antibiotic era, but with early diagnosis, modern therapy and supportive measures they have been less than 10% . A revised form for reporting cases, currently being considered by provincial epidemiologists across Canada, could help to provide more clinical and epidemiologic information. Ned Tijdschr Geneeskd, 1989 Sep 9, 133(36), 1796 - 800 {2 families with meningococcal infection and a hereditary disorder of the 5th component of the complement system}; Fijen CA et al.; Within a period of six months, a 20-year-old female with a homozygous deficiency of the C5 component of complement developed meningococcal meningitis twice (different serogroups) . Additional C5 deficiencies were not found in relatives . Homozygous deficiency of C5 was also present in another family in which a 16-year-old female and an 18-year-old sister suffered from meningococcal meningitis . Some characteristics of meningococcal disease in patients with C5 deficiency differed from meningococcal disease in patients with a normal complement system: meningitis occurred at a relatively advanced age, was associated with serogroups W-135, B and X and recurred in two of three patients. Lancet, 1989 Sep 9, 2(8663), 585 - 8 Complement deficiencies in patients over ten years old with meningococcal disease due to uncommon serogroups; Fijen CA et al.; 46 patients in whom meningococcal disease due to serogroups X, Y, Z, W135, or 29E had developed after the age of 10 years were investigated retrospectively for complement deficiency . Complement deficiency was found in half of the patients: properdin deficiency in 9 patients, C3 deficiency syndromes in 5, and homozygous deficiency of a terminal component (C5, C6, C7, or C8) in 9 . Meningococcal infections recurred in 5 of the 9 patients with terminal complement component deficiencies but not in the other complement-deficient patients . The findings show that meningococcal disease due to uncommon serogroups is often associated with complement deficiency. S Afr Med J, 1989 Sep 2, 76(5), 214 - 5 Detection of bacterial antigens in cerebrospinal fluid by a latex agglutination test in 'septic unknown' meningitis and serogroup B meningococcal meningitis; Muller PD et al.; The latex agglutination test (Wellcogen) was evaluated specifically in cases of 'septic unknown' meningitis, with CSF findings characteristic of bacterial meningitis but with no bacterial organisms grown on CSF culture or seen on microscopy after Gram staining . In only 4 (12%) of 33 cases of 'septic unknown' meningitis were antigens identified in the CSF . This kit contains for the first time reagents for the detection of serogroup B Neisseria meningitidis antigens and was also evaluated for this bacteria . Only 6 (27%) of 22 serogroup B N . meningitidis cases were identified. An Esp Pediatr, 1989 Sep, 31(3), 280 - 5 {Short-term treatment of meningococcal infections}; Lopez Sastre J et al.; Based upon our previous experience on the treatment of meningococcal infections with satisfactory evolution when the fourth day of therapy was finalized and taking into account published experiences with four or less days of therapy, we realized a study on the efficacy of a four days therapy when venial meningococcal infections but of seven days when the serious ones . The results obtained were like the former ones we published concerning to death rate but having inferior number of complications . The results of our study suggest that meningococcal infections may be successfully treated according to seriousness, with a four or seven-day course of intravenous penicillin G (300,000 UI/kg/day) distributed in six "aliquots" each four hours . The possibility of a four-days therapy, not taking into account seriousness, is considered for every meningococcal infections. APMIS, 1989 Sep, 97(9), 839 - 44 Increased adherence to vaginal epithelial cells and phagocytic killing of gonococci and urogenital meningococci associated with heat modifiable proteins; Hagman M et al.; Urogenital Neisseria meningitidis were characterized with regard to serogroup, colony morphology, the presence of heat modifiable proteins (HMP), attachment to human vaginal and buccal epithelial cells, and phagocytic killing by polymorphonuclear leukocytes . The findings were compared with those on gonococci, and with those on meningococci isolated from blood or cerebrospinal fluid, with regard to colony morphology, HMP and piliation . The opacity colony morphology characteristic could be used to predict the presence of HMP in gonococci but not in meningococci, and sodium dodecyl sulphate polyacrylamide gel electrophoresis had to be used to demonstrate this surface protein . The urogenital meningococci, serogroup Y, attached significantly more efficinetly to vaginal epithelial cells in the presence of HMP and behaved in this respect like those of gonococci . Gonococci and meningococci containing HMP were more sensitive to phagocytic killing than those without HMP . Meningococci from opaque and transparent colonies and isolated from patients with meningococcal disease had no demonstrable HMP . They showed low adherence to vaginal and buccal epithelial cells, with no difference between organisms from opaque or transparent colonies. J Pak Med Assoc, 1989 Sep, 39(9), 239 - 40 Study of skin lesions in 221 patients of meningococcal disease; Jamil S; During a meningococcal outbreak, 221 patients were studied . A skin rash was present in 78 (35.3%) patients . Twenty one (11.3%) patients had a frankly purpuric rash, involving mainly the extremities and the remaining had a generalised macular or petechial lesions . Extensive purpuric lesions, involving mainly the extremities were associated with disseminated intravascular coagulation (DIC), shock and a fatal outcome . This peripherally distributed rash may be used as a clinical substitute for the laboratory tests that confirm DIC. Antimicrob Agents Chemother, 1989 Sep, 33(9), 1622 - 3 Comparative activity in vitro of 16 antimicrobial agents against penicillin-susceptible meningococci and meningococci with diminished susceptibility to penicillin; Perez Trallero E et al.; Broad-spectrum cephalosporins were very active against strains of Neisseria meningitidis with both penicillin susceptibility and diminished penicillin susceptibility . Ceftriaxone was the most active antibiotic . Increases in MIC for 90% of meningococci with diminished susceptibility to penicillin of greater than or equal to 16-fold were observed for amdinocillin, cefuroxime, aztreonam, and imipenem; 2-fold increases were observed for ceftazidime, mezlocillin, and piperacillin . No differences were observed for non-beta-lactam antibiotics. Cesk Epidemiol Mikrobiol Imunol, 1989 Sep, 38(5), 280 - 5 {Changes in indicators of nonspecific humoral immunity in carriers of N . meningitidis}; Tomasik E; The aim of the work was to assess the immunity response of the macroorganism to "sound" meningococcal carriership in relation to its length . Furthermore the author wanted to assess the state of immunity changes during the inter-epidemic period . Although the differences in the immunity response in different groups are not significant, they exist and correlate with data reported in the literature . The most important finding is that during the period of the maximum drop of IgG and IgM antibodies there is an increase of the IgA class of immunoglobulins and the C3 component of complement . This correlates with the maximum number of carriers in the investigated group . Despite existing described changes of non-specific humoral immunity, the author considers specific, in particular collective immunity which determines the epidemic process of meningococcal infections, decisive for the development of meningococcal carriership. APMIS, 1989 Sep, 97(9), 774 - 80 Serum antibodies to cross-reactive Neisseria outer membrane antigens in healthy persons and patients with meningococcal disease; Maeland JA et al.; Outer membranes (OMs) were prepared from the Neisseria meningitidis (Nm) strain 44/76, N . gonorrhoeae (Ng) NRL 8658, and N . lactamica (N1) ATCC 23970 . Paired serum samples from 16 patients with serogroup B Nm disease and single samples from 30 blood donors were tested for IgG antibody levels against the three OMs in indirect ELISA, before and after absorption of the sera with N1 OM . Immunoblot analysis was used to identify OM target antigens for cross-reacting and strain-specific antibodies . Most of the Nm- and NG-antibodies in sera from healthy adults were directed against OM antigens shared by the three Neisseria strains . Nm disease induced antibody formation against common Neisseria antigens, identified as the H.8 antigen and LPS determinants, against LPS determinants shared only by the Nm and Ng strains and against a variety of Nm-specific OM antigens . Very low levels of Nm-specific antibodies characterized the Nm patients in the acute phase . Also, the results indicate that the OM ELISA which has been used for the diagnosis of Nm disease, would be more useful if antibodies against common Neisseria antigens were removed from the sera before testing. J Med Microbiol, 1989 Sep, 30(1), 23 - 31 Detection of antibodies to common antigens of pathogenic and commensal Neisseria species; Cann KJ et al.; Sera from 29 children and six adults were used to investigate the nature of antigenic cross-reactivity between Neisseria polysaccharea, N . lactamica and N . meningitidis B,15P1.16 by immunoblotting . Major common antigens of 68-70 Kda, 60-65 Kda and 15-20 Kda were detected . Antibody directed against them uniformly decreased after absorption of the sera with the three different Neisseria species . Antigens of 55 Kda and 35 Kda specific to N . meningitidis, and one of 43 Kda specific to N . lactamica, were also demonstrated . Antibody against all antigens was more prevalent in bactericidal than in non-bactericidal sera, although these differences were statistically not significant . Differences in antibody prevalence between carriers of Neisseria spp . and non-carriers of these organisms were even less marked . Examination of sera by whole-cell enzyme-linked immunosorbent assay against N . meningitidis B,15P1.16 and N . lactamica gave an absorbance ratio of 1:1 . Only four sera from children showed no reactivity against the meningococcal strain . These common antigens are likely to be important in vaccine development. J Immunol, 1989 Sep 1, 143(5), 1703 - 9 Human IgA1 initiates complement-mediated killing of Neisseria meningitidis; Jarvis GA et al.; We studied the effect of human IgA1, the predominant IgA subclass in serum, on C-mediated killing of Neisseria meningitidis . We purified monomeric IgA1 from normal human serum and tetravalent meningococcal polysaccharide vaccinate serum by using the following successive chromatographic steps: jacalin lectin affinity, Superose 12 FPLC gel filtration, Mono Q FPLC anion exchange, and anti-IgG affinity . SDS-PAGE, ELISA, and Western immunoblot analyses of the IgA1 detected no trace of contaminating IgG or IgM . IgA1 initiated partial or complete lysis (62 to 100%) of nine group C strains by using either normal, hypogammaglobulinemic, factor B-depleted, or properdin-deficient human serum as a C source, but IgA1 was unable to effect killing in serum chelated with 10 mM MgCl2 and 10 mM EGTA . Lytic activity was dependent on the group C strain and the source of the IgA1; neither IgA1 preparation was bactericidal for all nine strains . Removal of the Fc portion of IgA1 with pepsin completely abolished bactericidal activity . We purified and radiolabeled C component C3, and found that IgA1 did not increase C3 deposition . With the use of a group C polysaccharide ELISA, we found that the vaccinate IgA1 had a high titer of group C polysaccharide antibody, whereas the IgA1 purified from normal human serum had no detectable group C polysaccharide specificity . Absorption of the vaccinate IgA1 with alum-bound group C polysaccharide did not affect the killing of a sensitive strain, but it did potentiate the killing of a previously resistant strain . Western immunoblots of whole cell lysates, outer membrane complex, and purified lipooligosaccharide showed that the bactericidal IgA1 was specific for several outer membrane proteins . Four of the proteins recognized by both IgA1 preparations had apparent Mr of 29, 42, 66, and 74 kDa . We conclude that IgA1, when bound to specific outer membrane proteins, can initiate lysis of group C meningococci via the classical C pathway, and that initiation of lysis is an Fc-dependent event which occurs without an increase in C3 deposition. Thromb Res, 1989 Aug 15, 55(4), 459 - 70 The quantitative association of plasma endotoxin, antithrombin, protein C, extrinsic pathway inhibitor and fibrinopeptide A in systemic meningococcal disease; Brandtzaeg P et al.; We have evaluated the quantitative relationship between lipopolysaccharide (LPS, endotoxin), fibrinopeptide A (FPA), antithrombin (AT), protein C (PC) and extrinsic pathway inhibitor (EPI) in plasma from 39 consecutively admitted patients with systemic meningococcal disease (SMD) . The most severely ill patients with fulminant meningococcal septicemia (n = 13, 6 dead) had significantly (p less than 0.01) higher plasma levels of LPS and FPA and lower levels of PC and AT on admission as compared with the less severe clinical presentations (n = 26, 1 dead) . The levels of EPI on admission were significantly (p less than 0.05) higher in nonsurvivors vs survivors with fulminant septicemia . As the disease progressed, the levels of LPS, FPA, AT and PC declined, while the levels of EPI increased . Three of six nonsurviving septicemic patients had levels of EPI greater than 200% within 16 hours of admission vs two of 30 survivors (p = 0.02) . The results suggest that increasing levels of LPS in SMD elicit increasing consumption coagulopathy, contributing to the organ pathophysiology . The kinetics of EPI, inhibiting the thromboplastin-FVIIa-FXa complex, differs markedly from the kinetics of AT and PC i.e . increases as opposed to decreases. Eur J Pediatr, 1989 Aug, 148(8), 758 - 60 Familial deficiency of the seventh component of complement associated with recurrent meningococcal infections; Nurnberger W et al.; We describe an 11-year-old girl suffering from recurrent meningitis with a complete absence of the seventh component of complement (C7) . Diagnosis was established by haemolytic titration and western blotting . The patient's serum lacked the 85 kDa C7 chain . Haemolytic activity of serum was reconstituted with either pooled normal human serum or with purified C7 . The relatives (parents and one sister) had half-normal levels of both immunochemically and functionally determined C7, indicating a heterozygous state for C7 deficiency. J Intern Med, 1989 Aug, 226(2), 113 - 6 An evaluation of the accuracy of clinical diagnosis at admission in a population with epidemic meningococcal disease; Mathiassen B et al.; The accuracy (sensitivity and positive predictive value) of the clinical diagnosis given by the general practitioner before admission to hospital was evaluated retrospectively in a population with epidemic meningococcal disease . The study population consisted of approximately 32,000 subjects . In a 12-year period, 344 patients were discharged from hospital with CNS infections, 274 of whom were admitted with a diagnosis suspecting a CNS infection . A further 401 patients were admitted with suspicion for, but discharged without a CNS infection . Overall, the sensitivity was 79.7% and the positive predictive value was 40.6% . There were no significant changes in the accuracy during the study . The sensitivity differed significantly between the age groups (P less than 0.001) and was lowest among the adults (15+ years, 67.9%) and the 0-2-year-old children (72.7%) . Also among the 0-2 year-olds, the positive predictive value was low (34.1%) and not significant, indicating that it was more difficult to obtain the correct clinical diagnosis in this group. Community Med, 1989 Aug, 11(3), 239 - 46 Assessing the value of different sources of information on meningococcal disease; Davies LA; Both the true incidence of meningococcal disease and the proportion of cases of meningococcal meningitis notified in England and Wales are not known . A comprehensive search for cases of meningococcal disease within a defined boundary, that of Greater Manchester, was made using various sources of information, for 1985 . Sixty-seven per cent of cases of meningococcal meningitis and 63 per cent of meningococcal disease were notified . Fifty-seven percent of cases were referred for further tests to the United Kingdom meningococcal reference laboratory . Only 79 per cent of cases were identifiable on Hospital Activity Analysis (HAA) data . Information was also sought on sources of notification, notification delay, delay in laboratory diagnosis and length of stay . There is considerable potential in reducing notification delay, after comparing dates of laboratory diagnosis and notification . Notification should be more complete . In the absence of this ideal, surveillance of meningococcal disease needs to rely on various sources of information to gain a complete picture of the disease . Management of contacts of cases and of outbreaks is impossible without prompt and complete notification. Immun Infekt, 1989 Aug, 17(4), 113 - 23 {Pathogenic neisseriae--model of bacterial virulence and genetic flexibility}; Meyer TF; The early stages of an infection with pathogenic Neisseriae are determined by receptor-mediated events that finally lead to the attachment and invasion of human mucous tissues . The factors participating in this process, the pili, OPA proteins, and perhaps lipopolysaccharide (LPS), are subject to complex genetic changes that enable the pathogens to produce multiple variant forms of these factors . Antigenic variation of the pathogenic Neisseriae permits both, the escape from the human immune response and the interaction with different cells and tissues of the human host . One of the intrinsic mechanisms of antigenic variation, i.e . genetic transformation, allows exchange and recombination of virulence genes between independent Neisseria strains in multiply infected individuals . Factors, such as IgA protease, alpha-factor, and the meningococcal capsule are attributed with further striking properties, and thus render the pathogenic Neisseriae as an excellent model for the investigation of bacterial virulence. Infect Immun, 1989 Aug, 57(8), 2425 - 9 Comparison of the abilities of different protein sources of iron to enhance Neisseria meningitidis infection in mice; Schryvers AB et al.; This study was done primarily to determine whether the previously observed specificity of the meningococcal transferrin and lactoferrin receptors for human proteins was maintained in vivo during meningococcal infection in mice . Preliminary experiments evaluating the choice of host strain, the age and sex of mice, and the growth conditions of the meningococci indicated that 45-day-old female Swiss Webster mice challenged with meningococci grown on low-pH, low-iron Mueller-Hinton agar plates were appropriate for this study . The comparison of transferrins and lactoferrins from different species demonstrated that only the human forms of these proteins were utilized by meningococci; there was significantly greater mortality among mice treated with iron-saturated human transferrin or lactoferrin (93 and 100%, respectively) than among those not treated or treated with iron-saturated bovine transferrin or bovine lactoferrin (0%) . Provision of exogenous hemoglobin also resulted in increased mortality, although not as great as that observed with amounts of transferrin with equivalent iron content, which parallels the more effective utilization of transferrin and lactoferrin in in vitro growth experiments . In addition, unlike with transferrin and lactoferrin, there was no difference in utilization of human and bovine hemoglobin in vitro or in vivo. Infect Immun, 1989 Aug, 57(8), 2318 - 23 Cloning and characterization of the structural gene for the class 2 protein of Neisseria meningitidis; Murakami K et al.; The class 2 protein of Neisseria meningitidis is the major outer membrane protein and a porin . A lambda gt11 bank of meningococcal chromosomal DNA was screened with monoclonal antibodies against gonococcal protein IB that cross-react with meningococcal class 2 protein . Three independent immunoreactive clones were isolated . DNA sequence analysis indicated that these clones included regions encoding the N-terminal portion of the class 2 protein . An oligonucleotide of 21 bases that was complementary to this sequence was synthesized and used as a probe for a second screening of the lambda gt11 bank . One of the positive clones isolated contained the complete gene, including the ribosome binding site, but lacked the promoter region . On the basis of the DNA sequence, a protein of 360 amino acids was predicted . Comparison of the predicted protein sequence with that of gonococcal protein I showed little homology in six regions constituting 29% of the total amino acids, while the remainder of the coding frame showed 81% homology of amino acid residues . The DNA homology in the immediate 5' and 3' noncoding sequences was very striking . Following the putative transcription terminator, the 3' DNA sequence contained a complex pattern of direct and inverted repeats having some similarity to the 3' sequence of the gonococcal protein IB gene and very close homology to a sequence located in the pilS1 region (R . Haas and T . F . Meyer, Cell 44:107, 1986), an area of the gonococcal genome containing silent pilin genes. Offentl Gesundheitswes, 1989 Aug-Sep, 51(8-9), 442 - 4 {Preventive health care in travel, especially vaccinations}; Volkmer KJ; Nearly 40 million journeys abroad were recorded from the Federal Republic of Germany last year . 60-70% of travellers going to southern countries seek medical advice for preventive measures, particularly in Public Health centres . Inquiries for vaccinations are prevalent . Current aspects of immunization against yellow fever, cholera, tetanus, polio, typhoid fever, hepatitis A, hepatitis B, rabies meningococcal meningitis, European tick-borne encephalitis, measles and tuberculosis are discussed . Finally, some remarks on malaria prevention, hygiene, health insurance and information services are given in brief. Vaccine, 1989 Aug, 7(4), 325 - 8 Comparative evaluation of potential components for group B meningococcal vaccine by passive protection in the infant rat and in vitro bactericidal assay; Saukkonen K et al.; Seventeen monoclonal antibodies to one of three main cell surface antigens of Neisseria meningitidis group B were tested for protective efficacy in the infant rat using as challenge seven strains of different class 2/3 protein serotypes, class 1 protein (P1) subtypes and LPS immunotypes . Type-specific protection indicated both by a reduction of bacteraemia and meningitis and survival of the animals was regularly obtained with antibodies to the P1 protein and to LPS . By contrast, only one of seven antibodies to the serotype-specific class 2/3 protein was protective, even though four of them were highly bactericidal . The animal protection test and in vitro bactericidal assay were otherwise concordant . These data form important guidelines for the design of vaccines to prevent group B meningococcal infections. Lancet, 1989 Jul 29, 2(8657), 260 - 3 Intercontinental spread of an epidemic group A Neisseria meningitidis strain; Moore PS et al.; Electrophoretic enzyme typing revealed that a single group A Neisseria meningitidis clonal complex, designated III-1, was responsible for recent epidemics in Nepal, Saudi Arabia, and Chad . Epidemiological investigations and enzyme typing profiles indicated that this clone was brought from South Asia to the Middle East by Muslims making their pilgrimage (haj) to Mecca, Saudi Arabia, in 1987 . Pilgrims who became group A carriers introduced this clonal group into sub-Saharan Africa on their return from the haj . The introduction of this clonal group into sub-Saharan Africa may be responsible for the current wave of epidemics affecting the region . Although the findings suggest that clonal virulence is an important factor in the development of epidemics of meningococcal disease, other factors also seem to be necessary for the development of an epidemic. Cesk Epidemiol Mikrobiol Imunol, 1989 Jul, 38(4), 213 - 20 {Changes in the age distribution of meningococcal diseases in Czechoslovakia}; Kriz B et al.; Based on an analysis of the specific morbidity by age, we tried to explain the development of the morbidity from meningococcal meningitis in the CRS during the past 35 years . After the epidemic of meningococcal meningitis at the beginning of the fifties, the morbidity had a declining trend to the mid-seventies . During the period between 1975 and 1984 there was a rising trend of the notified morbidity, while in the subsequent years a decline followed . From the analysis of the specific morbidity by age it is obvious that during the period between 1972-1986 a significant rise of the morbidity of the age groups 0-11 months, 15-19 years and 25-29 years occurred . Analysis of the morbidity of five-year cohorts of subjects born in 1947-1971 revealed that after 1977 ex post herd immunization of all cohorts occurred with the exception of the cohort born in 1947-1951 which acquired a maximum immunity state already in the epidemic at the beginning of the fifties . The authors express the hypothesis that these changes are directly associated with the antigenic changes of N . meningitidis. Rev Infect Dis, 1989 Jul-Aug, 11 Suppl 5, S1194 - 202 Quinolone therapy for infections of the central nervous system; Scheld WM; The rationale for use of quinolones in the treatment of central nervous system (CNS) infections is reviewed . Quinolones exert potent activity in vitro against many gram-negative meningeal pathogens . Given the concentrations attained in cerebrospinal fluid (CSF), however, activity against gram-positive organisms is marginal . As a group, the quinolones enter (penetrate) the CSF better than do any other class of antimicrobial agents . The percentage penetration into CSF is remarkably similar in animal models and in humans with meningitis receiving concurrent therapy . The relative rank order for CSF penetration is as follows: enoxacin and pefloxacin (approximately 50%) greater than ciprofloxacin and ofloxacin (approximately 20%-30%) . Certain quinolones have proven to be equivalent to conventional agents (e.g., third-generation cephalosporins) in the rate with which they eradicate bacterial gram-negative organisms from the CSF in experimental animal models of meningitis, but the serum concentrations have usually been higher than those achieved in humans . Despite these advantages, the concentrations in CSF remain low (e.g., ciprofloxacin, approximately 0.25-0.5 mg/L; pefloxacin, 4-8 mg/L) in humans because of the relatively low concentrations attained in serum . Thus, quinolones will continue to be most useful in the treatment of infections due to problem pathogens or to multiresistant pathogens (e.g., Pseudomonas species) . Although quinolones appear to enter brain tissue readily, it is unlikely that they can be used as single agents for the treatment of brain abscess because of poor activity against anaerobes and streptococci, and no animal or human studies have been reported . A single dose of ciprofloxacin administered orally appears promising for use in eradication of the meningococcal carrier state. Cesk Epidemiol Mikrobiol Imunol, 1989 Jul, 38(4), 221 - 7 {Specific antibody response in carriers of N . meningitidis}; Tomasik E et al.; When investigating the specific immune response, the authors found that as many as 97.95% subjects in the investigated community had positive titres of anti A meningococcal antibodies . The values of geometrical means of anti A antibody titres varied between 16.85 and 20.25 . Short-time carriers have substantially higher antibody levels than long-term carriers, the difference being statistically significant p less than 0.001 . In the course of the investigation antibody levels rose despite the fact that meningococci of group A were not isolated . The position as regards anti C meningococcal antibodies is much worse . There the percentage of positivity is only 24.48% and the values of the geometrical means of titres in positive subjects varied between 7.78 and 8.48 . On the whole group of subjects the values were, however, 2.09-2.42 . This means they did not by far reach the value of the 1:6 titre, which is considered the first positive titre . Similarly as in anti A antibodies, there is a significant difference between the antibody level in short-term and long-term carriers in favour of the short-term ones. J Infect, 1989 Jul, 19(1), 69 - 74 Meningococcal disease in Italy; Stroffolini T et al.; In 1985, nationwide surveillance of meningococcal disease aimed at establishing appropriate guidelines for prophylaxis started in Italy . The incidence of disease was 1.1/100,000 in 1985 and 0.6/100,000 in 1987 . This decreasing trend was particularly evident among military recruits (from 17.3/100,000 in 1985 to 5/100,000 in 1987), reflecting the use of bivalent serogroup (A + C) meningococcal polysaccharide vaccine in all new recruits since January 1987 . The age distribution of cases was statistically different from that observed during the 1970s (P less than 0.001), with a shift towards older age groups . Men have been in the majority (516 vs . 358, P less than 0.0000001) . Group C has been the most common serogroup encountered (72.2%), while only 18% of the isolates belonged to serogroup B . Among military recruits, serogroup C accounted for 92% (81/88) of the cases . The proportion of strains resistant to sulphonamides was 67%, while only 3% strains were resistant to rifampicin and to minocycline . Reduced susceptibility to ampicillin and to penicillin was observed in 3 and 4% strains respectively . Nine secondary cases were all due to failure in the administration of chemoprophylaxis (sulphonamide given in seven cases, prophylaxis not attempted in two cases) . Immunisation of all new military recruits and effective chemoprophylaxis of close contacts of cases are the major guidelines provided by the National Meningitis Surveillance Programme. J Pak Med Assoc, 1989 Jul, 39(7), 177 - 9 Neisseria meningitidis storage identification and MIC determination; Hafiz S et al.; The significance Minimum Inhibitory Concentration (MIC) of determination for Meningococci is described and according to the present study a shift in the sensitivity of Meningococcus is occurring, local isolates show higher Minimum Inhibitory Concentration for Chloramphenicol and Azactam . Strains of Meningococcus can successfully be stored in a domestic freezer. J Bone Joint Surg Am, 1989 Jul, 71(6), 920 - 8 Chondro-osseous growth abnormalities after meningococcemia . A clinical and histopathological study; Grogan DP et al.; The cases of nine children who survived the acute stage of meningococcal septicemia and secondary disseminated intravascular coagulation were reviewed . All of the children had major orthopaedic problems as a result of the acute disease . Detailed histological studies were performed on specimens of bone and cartilage, obtained when these patients had either acute amputation for gangrene or subsequent revision for a chondro-osseous deformity . In the specimens that were obtained from the children who had acute gangrene, the histological changes included small-vessel thrombi, osteonecrosis, subperiosteal new-bone formation, cortical disruption, cellular disorganization in the physis, and medullary inflammation . These findings were compatible with a combination of inflammation (acute osteomyelitis) and ischemia . In the specimens that were obtained during revision of the amputation, three years or more after the initial infectious or ischemic process, the clinically relevant findings involved the epiphyses and physes . The growth plates showed variable permanent ischemic damage . Bone bridges connecting the epiphysis and metaphysis were observed in various stages of formation, including several early bridges with involvement of only the physis and metaphysis . Endosteal and cortical bone, in contrast, showed complete recovery with no evidence of permanent ischemic damage . We concluded that children who survive meningococcal septicemia are at high risk for complex orthopaedic problems, both acute and chronic . The disseminated intravascular coagulation and focal infections of the acute phase are primarily responsible for the vascular injuries to the growing chondro-osseous tissues . Ischemic changes also selectively involve the physeal circulation, but may take several years to adversely affect longitudinal and transverse growth of bone. Infect Immun, 1989 Jul, 57(7), 2066 - 71 Sequence of the structural gene (rmpM) for the class 4 outer membrane protein of Neisseria meningitidis, homology of the protein to gonococcal protein III and Escherichia coli OmpA, and construction of meningococcal strains that lack class 4 protein; Klugman KP et al.; The structural gene (rmpM) of the class 4 outer membrane protein of Neisseria meningitidis has been cloned and sequenced . The derived amino acid sequence reveals a 218-amino-acid protein following a 22-amino-acid signal peptide . The protein shows 94.2% homology with protein III of Neisseria gonorrhoeae and shares its two potential disulfide loops . The protein also shares limited homology with Escherichia coli OmpA . N . gonorrhoeae protein III has been shown to elicit blocking antibodies that prevent the killing of serum-resistant strains by immune sera (P . A . Rice, H . E . Vayo, M . R . Tam, and M . S . Blake, J . Exp . Med . 164:1735-1748, 1986) . The very close homology of meningococcal class 4 protein with gonococcal protein III suggests that meningococcal outer membrane preparations containing class 4 protein may similarly stimulate blocking antibodies . In order to investigate the role of the class 4 protein in the pathogenesis of meningococcal infection, we have used an erythromycin resistance gene in developing two meningococcal strains that lack class 4 protein. J Biol Stand, 1989 Jul, 17(3), 249 - 58 Measurements of lipopolysaccharide (endotoxin) in meningococcal protein and polysaccharide preparations for vaccine usage; Tsai CM et al.; Lipopolysaccharide (LPS, i.e . endotoxin) present in meningococcal outer-membrane protein and polysaccharide preparations made for vaccine use was quantitated by a silver-stain method following SDS-PAGE . The reactivities of LPS in the preparations were also measured by rabbit pyrogenicity and Limulus amoebocyte lysate (LAL) assay . Although rabbit pyrogenicity and LAL assay are more sensitive than the silver stain method, the latter provided an actual amount of LPS present in the protein or in the polysaccharide . For a meningococcal protein preparation, rabbit pyrogenicity showed about one-tenth, and even less by LAL assay, of the actual amount of LPS . This is because protein-bound LPS in meningococcal protein preparations is about 10-fold less active in causing fever in rabbits, and 20- to 40-fold less active in the gelation of LAL than the same amount of a purified free LPS which is generally used as a reference in quantitating LPS in these two assays . As for the small amount of LPS present in a meningococcal polysaccharide preparation, similar LPS content was obtained when measured by the three methods suggesting that the LPS is not bound to the polysaccharide in contrast to that in the proteins mentioned above . The purified meningococcal LPS was pyrogenic in rabbits at 1 ng/kg. J Infect Dis, 1989 Jul, 160(1), 58 - 65 Complement activation and endotoxin levels in systemic meningococcal disease; Brandtzaeg P et al.; The activation state of the complement system in 39 consecutively admitted patients with systemic meningococcal disease was studied prospectively using two monoclonal antibodies reacting with neoepitopes exposed during complement activation . The fluid-phase C3 activation products and SC5b-9 (terminal complement complex) were strongly correlated to the levels of endotoxin (lipooligosaccharides, LOS) in plasma on admission (r = .79, P less than .0001 and r = .76, P less than .0001, respectively) and to fatality . Maximum complement activation in survivors occurred 7h (median; range 0-44 h) after initiation of antibiotic treatment . The most severely ill patients had the capacity to activate the whole complement cascade . In nonsurvivors, high-grade activation often continued until the patients died . The results suggest that LOS are important activators of complement in systemic meningococcal disease and that complement-activating products, in concert with other mediators, may contribute to the multiple organ failure and death occurring in the most severe cases. J Commun Dis, 1989 Jun, 21(2), 96 - 106 Meningococcal meningitis in an industrial area adjoining Surat City--some clinico-epidemiological aspects; Bhavsar BS et al.; An industrial area with poor sanitation and inhabited by migrant, male predominant population, situated South to Surat City, experienced an outbreak of pyogenic meningitis during 1985-87 . A total of 197 cases of meningitis with 34 deaths were reported during a period of 1 1/2 years . Neisseria meningitidis was the predominant pathogen isolated from 66 out of 138 CSF samples . Recently migrated males of productive age groups drawn from the States of Uttar Pradesh and Orissa were predominantly affected . Male to female ratio was found to be 7.2:1 . Nearly 2/3rd of the cases were reported during the dry colder months of winter and spring . Pregnancy and childbirth appeared to be important predisposing factors in females . Nine cases were reported from the family contacts of cases . Majority of the cases were labourers doing manual work. Ann Pediatr (Paris), 1989 Jun, 36(6), 357 - 64 {Deficiencies in humoral immunity}; Bremard-Oury C; B cell immune deficiencies are characterized by inadequate production of antibodies and/or low levels of one or more classes of immune globulins (IgG, IgA, IgM) or IgG sub-classes . They include: 1) severe deficiencies involving all the immune globulins (Bruton agammaglobulinemia, variable hypogammaglobulinemia); 2) selective deficiencies in immune globulins (IgA deficiency, IgM deficiency, deficiencies in IgG sub-classes, dysgammaglobulinemias); 3) transient infantile hypogammaglobulinemia; 4) B cell immune deficiencies with normal gammaglobulin levels . Symptoms of B cell immune deficiencies are variable but respiratory manifestations are usually more prominent than the other features that include digestive disorders, fungal infections, autoimmune conditions, joint manifestations, and severe bacterial or viral infections (pneumococcus, meningococcus, enterovirus) . Management of IgM and IgA deficiencies rests on antimicrobial agents and non-specific measures . The prognosis of the other B cell immune deficiencies has improved dramatically since effective replacement immune globulin therapy has become available; this treatment combined with antimicrobial therapy and chest physiotherapy can usually prevent development of bronchiectases . The main risk is chronic enteroviral neuromeningeal infection. J Neurol Neurosurg Psychiatry, 1989 Jun, Suppl, 18 - 21 Is "Parkinson's disease" one disease? Calne DB. Consideration is given to how and why categories of ill health are divided into diseases . Aetiology is a fundamental criterion for the delineation of individual diseases . The same clinical and pathological picture may have many different causes; for example meningococcal meningitis and pneumococcal meningitis are distinct diseases that may display the same symptoms and signs . On the other hand, a single aetiology may lead to quite separate clinical and pathological phenomena; for example, neurosyphilis is a disorder that can present with general paresis or tabes dorsalis (or any combination of the two) . In attempting to find a nosological placement for Parkinson's disease, we must take into account the extensive overlap with idiopathic dementia (Alzheimer's disease) . Present evidence raises the possibility of several causes for Parkinson's disease, some of which may also be responsible for idiopathic dementia . A classification in accord with its position is desirable, and as a first step it would be helpful to replace "Parkinson's disease" with a term that is not saddled with implications of a single causal mechanism . "Idiopathic Parkinsonism" is suitable nomenclature for what is really a syndrome of unknown origin. Zh Mikrobiol Epidemiol Immunobiol, 1989 Jun, (6), 29 - 34 {Immunological factors in the evolution of the epidemic process in meningococcal infection}; Demina AA et al.; The results obtained in 1987 in the study of the immunostructure of the population of Yaroslavl with respect to meningococcal polysaccharides, groups, A, B, C, and lipopolysaccharide are presented in comparison with earlier results obtained in 1976 . The regulating role of the immunological factor in the evolution of the epidemic process of meningococcal infection has been confirmed . The level of antibodies to meningococcal polysaccharides, groups A and B, has been found to reflect the intensity of the circulation of the infective agent among the population . The comparison of the results of investigations carried out in 1976 and 1987 has revealed the essential role of the lipopolysaccharide antigen in the formation of the postinfection immunity of the population to meningococcal infection, irrespective of the group of the infective agent. Mol Immunol, 1989 Jun, 26(6), 523 - 9 Interaction of meningococcal group B monoclonal antibody and its Fab fragment with alpha 2-8-linked sialic acid polymers: requirement of a long oligosaccharide segment for binding; Hayrinen J et al.; Mouse monoclonal IgG2a antibody (735D4) and other antibodies to the capsular polysaccharide of group B meningococci have been shown to require an unusually long segment of the alpha 2-8-linked N-acetylneuraminic acid polymer for binding . This property may be due to a conformational nature of the polysaccharide epitope recognized, or alternatively due to the requirement of bivalent binding of the antibody to the polysaccharide . In order to study the binding requirements, Fab fragments were prepared from the monoclonal antibody and their binding to alpha 2-8-linked sialic acid polymers of different lengths was studied . Both the intact antibody and its Fab fragment bound to sialic acid poly- and oligomers to similar extents, the critical chain length being about 10 sialyl units for both molecules . This excluded bivalency as the explanation for the requirement of a long oligosaccharide segment for binding . Although the binding was enhanced with increasing chain length, the first 10 monosaccharides were calculated to contribute to more than 90% of the total binding energy . This is in agreement with an oligosaccharide segment with defined conformational epitope binding to the antibody combining site . The antibody preparations also bound polysialic acid containing glycopeptides isolated from developing human and rat brain, suggesting, in quantitative binding assay, an average chain length of 10 or more sialic acid residues . The interaction of the antibody with both the bacterial and the tissue derived polysialic acids suggests that the conformational epitope critical for the interaction is formed by both classes of compounds. Microb Pathog, 1989 Jun, 6(6), 455 - 8 Protective efficacy of mouse serum to the N-propionyl derivative of meningococcal group B polysaccharide; Ashton FE et al.; The protective properties of antibodies induced by immunization of mice with a conjugate of tetanus toxoid and the N-propionyl derivative of group B meningococcal polysaccharide (N-Pr-GBMP-TT) have been investigated . Mice immunized with the conjugate produced antibodies which were bactericidal for Neisseria meningitidis strains B:2b:P1.Ham and B:15:P1.16 . Passive protection studies indicated that the conjugate serum completely eliminated or reduced considerably levels of bacteremia by the same strains in mice . There was no bactericidal activity or passive protection against a strain of N . meningitidis C:2b:P1.2 . Following absorption of the conjugate serum with GBMP the non-absorbed antibody, directed to N-Pr-GBMP, was bactericidal and protected mice against bacteremia with group B meningococci . Thus N-Pr-GBMP antibodies which do not bind to the GBMP are protective in vitro and in vivo. N Z Med J, 1989 May 24, 102(868), 243 - 5 The clinical features of paediatric meningococcal disease Auckland, 1985-87; Voss L et al.; An epidemic of group A meningococcal disease began in Auckland in May 1985 . There were 122 paediatric cases of meningococcal disease in the next 25 months including 98 cases due to group A . The commonest clinical symptoms were vomiting, headache and photophobia, while frequent signs included fever, seizures, petechial rash and meningism or a bul