Zh Mikrobiol Epidemiol Immunobiol, 1988 Jan, (1), 65 - 8 {Evaluation of the level of antibodies to purified meningococcal antigens}; Kuznetsova EM et al.; Group B meningococcal antigens, such as polysaccharide, lipopolysaccharide, protein preparation, as well as sonicates obtained from meningococcal cells, groups A, B and C, have been isolated . On the basis of these preparations the parameters of an enzyme immunoassay system for the detection of antibodies to individual meningococcal antigens have been established, and the specificity of the system and the possibility of using it for the evaluation of the level of antibodies to meningococci in human sera have been studied. Zh Mikrobiol Epidemiol Immunobiol, 1988 Jan, (1), 11 - 5 {Synthesis of group-specific polysaccharide by different strains of Neisseria meningitidis serogroup B under various conditions}; Sivtseva LD et al.; Sonicated lysates of 5 N . meningitidis strains, serogroup B, obtained from two solid serum-free culture media (a medium with casamino acids and a medium with Hottinger's hydrolysate) were studied with the aim of comparing the capacity of different group B meningococcal strains for the accumulation of group-specific polysaccharide . In the lysates obtained after 7-hour growth no sialic acid was found . After 20-hour cultivation, group-specific polysaccharide was detected in the lysates obtained from 4 out of 5 strains . All sonicated lysates obtained in these experiments were serologically active . The lysates obtained from the medium containing casamino acid had a higher content of group-specific polysaccharide . N . meningitidis strain 125, obtained at the Mechnikov Central Research Institute for Vaccines and Sera (Moscow) by selection, showed the highest content of capsular polysaccharide in microbial cells and the stable yield of biomass. Scand J Infect Dis, 1988, 20(1), 21 - 31 Endotoxin liberation associated with growth, encapsulation and virulence of Neisseria meningitidis; Andersen BM et al.; Endotoxin liberation, encapsulation and growth was studied in 123 isolates of Neisseria meningitidis . Free endotoxin appeared in culture filtrates during exponential growth . Meningococci with free endotoxin titre greater than or equal to 10(2) (E+) showed a higher mean number of viable bacterial counts (CFU/ml) during growth than isolates with titre less than 10(2) (E-), p less than 0.001 . Differences in endotoxin liberation was, however, far more pronounced than what was indicated by growth differences alone . E+ property and increased growth rate was significantly more often found among encapsulated than non-encapsulated meningococci . Within the serogroup B isolates, there tended to be a higher mean number of CFU/ml during growth in E+ than E- meningococci, particularly among carrier isolates studied separately (p = 0.009) . Case isolates of B meningococci, which had generally a higher amount of capsular material and a higher proportion of E+ strains, had also higher mean CFU/ml than B carrier isolates . This indicates that the endotoxin liberation and growth may be correlated to presence and amount of capsular polysaccharide . Endotoxin liberation, presence of capsular polysaccharide and growth ability are 3 factors which are likely to coincide in meningococci . This combination of properties may be of importance for the development of meningococcal disease. Infect Immun, 1988 Jan, 56(1), 259 - 66 T-cell modulation of the murine antibody response to Neisseria meningitidis group A capsular polysaccharide; Muller E et al.; T-cell modulation of the antibody response of BALB/c mice to group A meningococcal capsular polysaccharide (PS) was examined by using an enzyme-linked immunosorbent assay . An optimal dose (5 micrograms) of antigen induced an immunoglobulin M (IgM) response of short duration; no IgG or IgA antibody could be detected . The capacity to produce serum antibody begins at about 3 weeks of age . Concanavalin A (ConA) inhibited the magnitude of the response by 40 to 60% when given at the time of immunization; it enhanced the response two- to eightfold when given 2 days after PS . T-cell-mediated suppression could be transferred to naive mice by injection of spleen cells from low-dose-primed mice . A secondary antibody response could be induced by immunization with live meningococci . Here, the IgM response was 8- to 10-fold greater than that of mice given an optimal dose of PS; IgG antibody against group A PS increased 1 week after immunization to levels that were 100- to 1,000-fold greater than those of mice immunized with PS . The antibody response could not be augmented by multiple injections of PS; suppression occurred after low-dose priming or hyperimmunization with PS . These studies indicate that the antibody response to PS is not completely T-cell independent; rather, it is inhibited and amplified by T cells. Epidemiol Rev, 1988, 10, 191 - 211 Epidemiology of acute necrotizing ulcerative gingivitis; Melnick SL et al.; In the last 60 years, there have been approximately 50 studies of various suspected risk factors associated with acute necrotizing ulcerative gingivitis . Two thirds of these studies have been either surveys or case reports; nearly all the rest have been case-control studies . There have been only a few longitudinal and population-based studies, most of which were in high-risk populations . The findings of many studies pertain to gingivitis in general rather than in acute necrotizing ulcerative gingivitis in particular; the findings of other studies are based on small numbers or solely on case histories without the inclusion of control subjects . There are comparisons between the epidemiology of acute necrotizing ulcerative gingivitis as it occurs in military populations and the epidemiology of meningococcal meningitis (98-103) . Both diseases have been reported in closed communities such as in young recruits away from home and in new surroundings . A temporal trend upward in disease frequency was described for both infections during World War II . Both infections appear to be characterized by low communicability, with no documented transmission by fomites or vectors . Furthermore, active disease in both cases is associated with markedly increased numbers of normally indigenous flora: B . intermedius in the case of acute necrotizing ulcerative gingivitis and Neisseria meningococcus in the case of epidemic meningococcal meningitis . Risk factors associated with both diseases include crowding, physical fatigue, increased stress, low socioeconomic status, and failure of host defense mechanisms . In general, there is potential for longitudinal studies of young people such as new military recruits and college students who are undergoing the transition from dependence to independence . It is intriguing that these young adults are suddenly at increased risk of this disease in late adolescence when they should be at peak fitness and, just as suddenly, at decreased risk after their early thirties . It appears that the dynamic tension between bacterial agents, environmental stressors, and host defense mechanisms is abruptly altered in certain young people, allowing the characteristic lesions to develop . Furthermore it appears that, in the United States at least, the disruption is limited primarily to white people relative to black people . It is possible that disease develops because young adults are brought together from diverse locations and perhaps exposed to a new microbial agent . However, acute necrotizing ulcerative gingivitis has not been demonstrated clearly to be transmissible, and if it is, the mode of transmission is not known.(ABSTRACT TRUNCATED AT 400 WORDS) Pediatr Radiol, 1988, 18(5), 427 - 8 Ultrasound diagnosis of adrenal hemorrhage in meningococcemia; Sarnaik AP et al.; Two cases of adrenal hemorrhage in meningococcemia detected by ultrasound are reported . Antemortem detection of adrenal pathology may have important prognostic and therapeutic implications . The sonographic appearance may be echo-free, mixed, or echogenic . Abdominal ultrasound examination can be an effective non-invasive tool in diagnosing adrenal hemorrhage. Ter Arkh, 1988, 60(2), 59 - 64 {The enzyme diagnosis of liver involvement in meningococcal infection}; Radzivil GG et al.; A complex of blood enzymes (AST, ALT, AP, GTT) was studied in 84 patients with generalized forms of MI . The study showed that signs of liver involvement were noted in 15.4% of the patients on the 1st day of disease . Laboratory signs of cytolysis and cholestasis were revealed in most examinees on the 7th-15th day of disease during a dynamic follow-up . The most noticeable syndromes were revealed in young patients (30 persons) with brain edema (42.2%) . Primary liver involvement (i . e . noted on admission to hospital) in 6 patients was associated with MI toxic effects, in 7 patients--with a severe concomitant pathology of the pulmonary and cardiovascular system . Delayed liver involvement was detected in 55.3% of the young patients and in half of the elderly patients . It was established that a course of disease was accompanied by the affection of many organs from the first days complicating the interpretation of enzymological data therefore requiring combined enzymological investigations. J Med Virol, 1988 Jan, 24(1), 33 - 44 BK virus infection in children with cancer: serological response studied by haemagglutination inhibition, neutralization, and IgG- and IgM-class specific ELISA tests; Flaegstad T et al.; We recently developed enzyme-linked immunosorbent assays (ELISAs) for the detection of anti-BK virus IgG- and IgM-antibodies, and also a convenient and rapid serum neutralization test . Complemented by a traditional haemagglutination inhibition test (HAI) these methods were used to investigate the longitudinal response to BKV infection in sequentially taken sera from 29 children under treatment for cancer . In separate experiments it was shown that the results were not at any extent influenced by antibodies against other polyomaviruses . At the time of diagnosis the prevalence of specific IgG- and IgM-antibodies and the geometric mean IgG levels were not significantly different for the patients compared with a group of healthy children . The primary infections seemed to occur at the same age for the two groups of children . Seven of the patients had a primary infection with BKV . The results indicate that the host response in moderately immunosuppressed children during primary infection is the same as expected for healthy individuals with the development of specific IgG, HAI, and NT antibodies, and, usually, production of BKV-IgM for several months . The results indicated that whether specific IgM was demonstrated in the first sample or appeared later during a reactivation episode, this parameter was correlated with profound immunosuppression . Significant titre changes, detectable IgM antibodies and/or seroconversions were demonstrated in 69% (20/29) of the cancer patients . Such indications of recent viral activity was recorded in 42% (8/19) of children with meningococcal infections . The observation periods for the two groups of patients are, however, not directly comparable. Adv Exp Med Biol, 1988, 228, 495 - 550 Chemically modified capsular polysaccharides as vaccines; Jennings HJ; Capsular polysaccharides have assumed an important role as vaccines against disease caused by bacteria in humans . The concept of using pure definable polysaccharides devoid of their accompanying complex bacterial mass is technically elegant and is obviously capable of extension into other areas of immunoprophylaxis . However, problems have been identified which will need to be solved in order that the concept may be more widely adopted . Focusing on the meningococcal polysaccharides, possible solutions to two of these important problems, namely, the poor immunogenicity of the A and C polysaccharides in infants, and the poor immunogenicity of the B polysaccharide in all humans, are proposed . These solutions involve the use of a new generation of artificial synthetic antigens for modulating the immune response . For instance, conjugation of the A and C polysaccharides to tetanus toxoid converted them to T-cell dependent antigens in mice, thus making these conjugates potential infant vaccine candidates . Although a similar conjugation of the B polysaccharide failed to substantially enhance its immunogenicity in mice, this could be achieved by further chemical manipulation of the basic structure of the B polysaccharide . N-propionylation of the B polysaccharide, followed by its conjugation to tetanus toxoid, yielded an antigen, which when injected in mice, induced in them high titers of cross-reactive B polysaccharide-specific IgG antibodies . The chemical modification of polysaccharides requires an understanding of the interrelation between their structures and immunospecificities, and the structural elucidation of polysaccharides and the resultant monitoring of their structural modifications, can be conveniently accomplished using a wide range of NMR spectroscopic techniques . The capsular polysaccharides of many of the bacteria which cause meningitis in humans contain sialic acid and have extensive structural homology with human tissue . As a result of this homology the immunospecificities of these polysaccharides are complex, being based on unconventional conformational determinants. Zh Mikrobiol Epidemiol Immunobiol, 1988 Jan, (1), 58 - 61 {Cross reactions between Staphylococcus aureus and Neisseria meningitidis}; Vaneeva NP et al.; The results of the study of rabbit antisera to meningococci A, B, C in the double diffusion in gel, passive hemagglutination test and enzyme immunoassay with antigenic preparations isolated from S . aureus strains are indicative of the presence of common antigenic determinants of protein and polysaccharide nature in S . aureus and N . meningitidis. J Infect Dis, 1988 Jan, 157(1), 47 - 53 Functional activities of monoclonal antibodies to the O side chain of Escherichia coli lipopolysaccharides in vitro and in vivo; Kim KS et al.; Mouse hybridoma antibodies (IgG and IgM) to O side chain determinants of Escherichia coli strain Bort (O18ac:K1:H7) were evaluated for their in vitro and in vivo activities against E . coli strains . Both IgG and IgM were opsonic in vitro and protected newborn rats challenged with a K1 E . coli strain, but their activities were strain specific . The antibodies protected against a K1 strain possessing a homologous O serotype but not against one possessing a heterologous O serotype . These antibodies were not effective against the K5-encapsulated O18 E . coli strain (possessing a homologous O type) but protected against its unencapsulated derivative . The opsonic and protective activities of these antibodies were significantly greater with IgG than IgM . Both IgG and IgM, however, required complement for their activities . When IgM to lipopolysaccharide was given to newborn rats in conjunction with IgM monoclonal antibody to the group B meningococcal polysaccharide, the protective effect was significantly greater than that of either antibody alone . Combinations of two (or more) antibodies to different cell wall components may be more beneficial in preventing and treating E . coli infection. Biochemistry, 1987 Dec 15, 26(25), 8399 - 405 Conformational differences between linear alpha (2----8)-linked homosialooligosaccharides and the epitope of the group B meningococcal polysaccharide; Michon F et al.; The alpha-(2----8)-linked sialic acid oligosaccharides (NeuAc)n exhibit an unusual degree of heterogeneity in the conformation of their linkages . This was diagnosed by observation in their 13C NMR spectra of an equivalent and unique heterogeneity in the chemical shifts of their anomeric carbons and subsequently confirmed by more comprehensive 1H and 13C NMR studies . In these studies both one-dimensional and two-dimensional experiments were carried out on the trisaccharide (NeuAc)3 and colominic acid . In addition to the unambiguous assignment of the signals in the spectra, these experiments demonstrated that both linkages of (NeuAc)3 differed in conformation from each other and from the inner linkages of colominic acid . The NMR data indicate that these conformational differences extend to both terminal disaccharides of oligosaccharides larger than (NeuAc)5, a result that has considerable physical and biological significance . In the context of the group B meningococcal polysaccharide, it provides an explanation for the conformational epitope of the group B meningococcal polysaccharide, which was proposed on the evidence that (NeuAc)10, larger than the optimum size of an antibody site, was the smallest oligosaccharide able to bind to group B polysaccharide specific antibodies . Because the two terminal disaccharides of (NeuAc)10 differ in conformation to its inner residues, the immunologically functional part of (NeuAc)10 resides in its inner six residues . This number of residues is now consistent with the maximum size of an antibody site. Eur J Epidemiol, 1987 Dec, 3(4), 399 - 403 A one year survey of meningococcal disease in Italy; Stroffolini T et al.; For the last ten years, meningococcal disease has been endemic in Italy with an annual average of 900 cases (rate of 1.6/100,000) . The age specific attack rate has been highest for children under one year of age, and the majority of cases have been due to serogroup B . During 1985, the epidemiology of meningococcal disease changed substantially: twice as many cases were observed in males as in females . There was a shift toward older age groups, with the highest number of cases occurring in the 15-24 year old age group (25%) . The frequency in army recruits was 17.3/100,000, as opposed to 1/100,000 for the general population . Serogroup C caused the majority of cases (75.8% of the isolates) . The proportion of strains resistant to sulfonamides was 71.1%, while only one strain was resistant to rifampin and none to minocycline . Seven secondary cases occurred (2%): in five, chemoprophylaxis was inappropriate (sulfonamide), and in two, no drug was given . A single co-primary case was seen . We conclude that in Italy, the use of sulfa drugs as chemoprophylactic agents is not warranted at present, compulsory vaccination of army recruits with bivalent vaccine (A + C) is advisable, and the shift in age distribution of cases and the high predominance of serogroup C increases the need for careful surveys. Mayo Clin Proc, 1987 Dec, 62(12), 1137 - 41 Prophylactic use of antimicrobial agents in adult patients; Van Scoy RE et al.; Prophylactic antimicrobial agents are recommended for prevention of a variety of conditions, including tuberculosis, endocarditis, rheumatic fever, recurrent cellulitis and lymphangitis in patients with lymphedema, meningococcal meningitis, bite wounds, and herpes virus infections . In addition, prophylactic antimicrobial agents have proved effective in certain surgical procedures such as a variety of abdominal operations, hysterectomy, and head and neck operations for cancer . Except for oral bowel preparations, administration of antimicrobial agents for prophylaxis should be limited, in general, to the perioperative time period . Doses given more than an hour before or 3 hours after a surgical procedure have not been shown to increase effectiveness, and such an approach increases the cost and the probability of toxicity and superinfection . Investigation of antimicrobial prophylaxis necessitates adequate evaluation of potential advantages and disadvantages in prospective double-blind fashion. Epidemiol Infect, 1987 Dec, 99(3), 579 - 89 An outbreak of meningococcal disease in Stonehouse: planning and execution of a large-scale survey; Stuart JM et al.; In November 1986 a large-scale survey was undertaken in the Gloucestershire town of Stonehouse during an outbreak of meningococcal disease due to group B type 15 subtype P1.16 sulphonamide-resistant strains . There were 15 cases in Stonehouse residents during the 4 years from April 1983, an annual attack rate of 56.5 per 100,000 . Four secondary cases occurred despite rifampicin prophylaxis . The objectives of this community survey were to investigate patterns of meningococcal carriage, transmission and immunity and to determine the proportion of non-secretors of blood group antigens in the Stonehouse population and amongst meningococcal carriers . A total of 6237 subjects participated including 75% of the 6635 Stonehouse residents . Over 97% of the participants provided all three of the requested specimens-nasopharyngeal swabs, saliva and blood samples . The co-operation between the many organizations involved in the detailed preliminary planning was instrumental in the success of the survey; in particular the value of effective collaboration between Departments of Community Medicine and Microbiology and of the Public Health Laboratory Service network of laboratories in undertaking investigations of this size and type was clearly demonstrated. Br J Hosp Med, 1987 Dec, 38(6), 516, 521 - 4 Meningococcal meningitis; Cartwright KA; Meningococci continue to cause outbreaks of disease throughout the world . The UK is currently experiencing an upsurge due to organisms of groups B and C . There is substantial under-reporting of meningococcal disease, only meningitis currently being notifiable . All significant meningococcal strains should be typed by a reference laboratory . New approaches to vaccine development permit cautious optimism for the future. Microb Pathog, 1987 Dec, 3(6), 445 - 53 Cloning of an outer membrane protein of Neisseria meningitidis in Escherichia coli; Tarkka E et al.; A gene bank of chromosomal DNA of Neisseria meningitidis group B was constructed in phage lambda EMBL3, and screened by rabbit polyclonal antibodies to major outer membrane (OM) proteins of the meningococcus . Several clones expressing a 28 kDa protein were found . The gene coding for the 28 kDa protein was subcloned into plasmid pUC18 in Escherichia coli . The protein was expressed in E . coli and located in the OM . Rabbit antibodies were raised to the 28 kDa protein purified from E . coli and used to localize the protein in the meningococcus . The antiserum recognized a minor protein of similar electrophoretic mobility in the outer membrane complex (OMC) of the meningococcus . The 28 kDa protein was found to be common to different Neisseria species; it was expressed by both pathogenic and nonpathogenic Neisseria. Acta Pathol Microbiol Immunol Scand {C}, 1987 Dec, 95(6), 283 - 9 Serum opsonins to group B meningococci; Sjursen H et al.; The production of serum opsonins and other antibodies to serogroup B serotype 15 meningococci was examined in 7 patients with serogroup B serotype 15 meningococcal disease and 7 volunteers immunized with a vaccine containing outer membrane proteins from serogroup B serotype 2b and 15 meningococcal strains complexed with polysaccharides from serogroups A, C, Y and W-135 meningococci . Serum opsonic activity was measured by a flow cytometric phagocytosis technique, using unfixed serogroup B Neisseria meningitidis labelled with fluorescein isothiocyanate . Serum antibodies to outer membrane complexes prepared from the meningococcal test strain, B:15:P1.16, were measured by an enzyme linked immunosorbent assay . The mean number of bacteria per phagocyte increased from 9.7 to 17.3 (mean difference 7.6, p less than 0.001) when the meningococci were opsonized with convalescent sera compared to sera obtained during the acute illness, and from 8.0 to 15.4 (mean difference 7.4, p less than 0.001) when opsonized with sera from immunized versus pre-immunized volunteers . The patients had insignificant amounts of serum antibodies to the group B meningococcal test strain on admission to hospital . Two weeks later all had a marked increase in IgG, IgM and IgA serum antibodies . Vaccination caused a marked increase in serum IgG antibodies . Serum opsonic activity and IgG levels were still high 6 weeks after the acute illness/immunization . A correlation was observed between serum opsonic activity and IgG antibody levels (r = 0.883, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS) Epidemiol Infect, 1987 Dec, 99(3), 591 - 601 The Stonehouse survey: nasopharyngeal carriage of meningococci and Neisseria lactamica; Cartwright KA et al.; A total of 6234 nasopharyngeal swabs was collected during a survey of the population of Stonehouse, Gloucestershire in November 1986 as part of an investigation into an outbreak of meningococcal disease . The overall meningococcal carriage rate was 10.9% . The carriage rate rose with age from 2.1% in the 0- to 4-year-olds to a peak of 24.5% in the 15- to 19-year-olds, and thereafter declined steadily with age . Male carriers outnumbered female carriers of meningococci by 3:2 . Group B (or non-groupable) type 15 sulphonamide-resistant strains which had caused the outbreak were isolated from 1.4% of subjects . The age distribution of carriers of these strains was similar to that of other meningococci apart from an additional peak in the 5-9-year age group and a more rapid decline in carriage with increasing age . Variations in the carriage rates of the outbreak strain were seen in children attending different schools and in the residents of different areas of the town . The low carriage rate of these strains in a community during a prolonged outbreak supports the hypothesis that these organisms are less transmissible but more virulent than other strains of pathogenic meningococci . Carriage of Neisseria lactamica, which is thought to be important in the development of meningococcal immunity, was most frequent in children under the age of 5 years and was six times commoner in this age group than carriage of Neisseria meningitidis . In older children and adults female carriers of N . lactamica increasingly outnumbered males in contrast to the male preponderance observed with meningococcal carriage. Lancet, 1987 Nov 21, 2(8569), 1165 - 9 Protective activity of Vi capsular polysaccharide vaccine against typhoid fever; Klugman KP et al.; The protective efficacy against typhoid fever of a single intramuscular injection of 25 micrograms of the Vi capsular polysaccharide (CPS) was assessed in a randomised double-blind controlled trial . Vaccination of 11,384 children was followed by 21 months' surveillance . 47 blood-culture-proven cases of typhoid occurred in children who received meningococcal A + C CPS vaccine and 19 cases in those vaccinated with Vi CPS . Protective efficacy was 60% calculated from the day of vaccination and 64% from 6 weeks after vaccination . Surveillance also included 11,691 unvaccinated children; 173 cases occurred in this group . Protective efficacy in relation to the unvaccinated group was 77.4% and 81.0% after 21 months, calculated immediately and 6 weeks after vaccination, respectively . Vaccination was associated with minimum local side-effects, and an increase in anti-Vi antibodies occurred, as measured by radioimmunoassay and enzyme-linked immunosorbent assay . Antibody levels remained significantly raised at 6 and 12 months post vaccination . Vi CPS is thus a safe and effective means of typhoid vaccination. Microb Pathog, 1987 Nov, 3(5), 351 - 63 Isolation by streptonigrin enrichment and characterization of a transferrin-specific iron uptake mutant of Neisseria meningitidis; Dyer DW et al.; The bactericidal action of the antibiotic streptonigrin is enhanced by large intracellular iron pools . Using this observation, we have utilized a simple enrichment protocol to aid in the isolation of iron uptake mutants of N . meningitidis, based on the relative resistance of iron-starved meningococci to streptonigrin . One such mutant, FAM29, was impaired in its use of transferrin-bound iron; transferrin is the principal iron-binding protein in human plasma . FAM29 retained wild-type ability to utilize iron bound to lactoferrin, heme, or ferric citrate . FAM29 did not produce two iron-repressible outer membrane proteins, of 85,000 and 95,000 daltons, made by the parent strain . However, genetic transformation experiments indicated that the outer membrane protein alterations were not necessary for the transferrin-deficient phenotype. Zh Mikrobiol Epidemiol Immunobiol, 1987 Nov, (11), 23 - 6 {Differences in the ultrastructure of colored variants of colonies of pathogenic Neisseria}; Dmitriev GA et al.; Electron-transparent zones (vacuoles) of different size and localization have been detected in the cytoplasm of meningococci forming orange colonies . These vacuoles have been detected in cells from meningococcal cultures of different age, grown both in liquid and solid culture media . This phenomenon requires further deeper study . The presence of a relationship between newly detected vacuoles and the pathogenicity of meningococci is suggested. Arch Dis Child, 1987 Nov, 62(11), 1113 - 7 Neisseria meningitidis in a primary school; Cann KJ et al.; A prospective study of the nasopharyngeal carriage of sulphonamide resistant Neisseria meningitidis, group B, type 15 P1.16, was undertaken after a cluster of four cases of meningococcal infections had occurred, two of which were fatal, during a three year period among children attending an inner London primary school . Throughout the year of the study the overall carriage and acquisition rates of meningococci were less than 6% and 1%, respectively, and were no different from those of control children of similar age and ethnic origin from another school . The outbreak strain was isolated from three children in the study school, however, but from none in the control school . A comparison of bactericidal activity in serum against the outbreak strain in children from selected classes in each school showed that there was no lack of bactericidal activity to this strain in the study school . The low prevalence of strain specific bactericidal activity in sera taken from classroom contacts of carriers, combined with the low carriage and acquisition rats, suggested a pattern of prolonged colonisation with infrequent transmission of the organism from child to child, and was consistent with the pattern of cases seen in the school. Infect Immun, 1987 Nov, 55(11), 2734 - 40 Molecular cloning and expression of Neisseria meningitidis class 1 outer membrane protein in Escherichia coli K-12; Barlow AK et al.; A genomic library of meningococcal DNA from a clinical isolate of Neisseria meningitidis was constructed in the expression vector lambda gt11 . Outer membrane complex was prepared from the same strain and used to immunize rabbits to raise polyclonal anti-outer membrane complex serum . The amplified library was probed with this polyclonal serum, and seven expressing recombinants were isolated; further investigations indicated these to be identical . The expressed meningococcal gene in these recombinants was fused to vector beta-galactosidase and shown to encode epitopes present on the 42-kilodalton class 1 outer membrane protein . Estimation of the size of the recombinant fusion protein suggests that up to 40 kilodaltons of protein-coding sequence is present . The lambda gt11 recombinant contains a 3.4-kilobase DNA insert, which has been recloned into a plasmid and characterized by restriction endonuclease analysis . A restriction fragment from the insert, representing the protein-coding region hybridizes to a single 2.2-kilobase XbaI fragment from the homologous strain and to similar-sized XbaI fragments in other strains of meningococci, expressing antigenically distinct class 1 proteins. J Biol Stand, 1987 Oct, 15(4), 373 - 8 The persistence of antibodies induced by meningococcal polysaccharides of groups A and C in human volunteers; Al-Shamma SM et al.; Ninety-nine college students (58 males and 41 females) aged 17 to 23 years were each injected subcutaneously with 50 micrograms of meningococcal polysaccharides A and C . Titrations of antisera obtained at various time intervals during the two subsequent years were made by passive haemagglutination microtitration using human O Rh-negative red blood cells from a single source . The percentage of responders (those who developed a fourfold increase in titre) to polysaccharide A was 97.9% and that to polysaccharide C was 94.8% . Pre-immunization titres of 16 to polysaccharide A and 8 to polysaccharide C were considered to be threshold values above which the response might be impaired . There was a significant (P less than 0.01) difference in the geometric mean HA titre between vaccinees and control groups after vaccination at each time interval studied . The majorities of both the vaccinees and the controls had a higher peak titre to polysaccharide A than to polysaccharide C. Immunology, 1987 Oct, 62(2), 249 - 53 Deficiency of the sixth component of complement and susceptibility to Neisseria meningitidis infections: studies in 10 families and five isolated cases; Orren A et al.; Complement component C6 deficiency (C6D) was diagnosed in 15 patients who presented, independently, with recurrent meningococcal infection . This condition is thus not particularly rare in the Cape . Ten of the patients belonged to multiplex families, and family studies led to the diagnosis of another 12 C6D cases among the siblings . Segregation analysis showed that C6D occurred more frequently among the siblings of affected individuals than would be expected for co-dominant inheritance . The possible reasons for this are discussed . We also observed that the 12 non-proband C6D siblings included only four with a history suggestive of meningococcal infection, and thus C6D individuals apparently differ in susceptibility to Neisseria meningitidis infection . We confirmed previous observations that primary infection occurs later in C6D individuals than amongst susceptible complement-sufficient individuals . Among 123 patients presenting with primary meningitis, one case of C6D was diagnosed . The data show that C6D is an important factor associated with susceptibility to meningococcal infection in the Cape. Ann Plast Surg, 1987 Oct, 19(4), 375 - 7 Management of skin loss in meningococcal infection; Ikeda C et al.; The case of a 17-month-old girl with fulminant meningococcemia is presented to illustrate the protean and fulminant course of the disease . Special attention is given to the meningococcal skin manifestation, with guidelines for its treatment. Microb Pathog, 1987 Oct, 3(4), 261 - 7 Protective efficacy of monoclonal antibodies to class 1 and class 3 outer membrane proteins of Neisseria meningitidis B:15:P1.16 in infant rat infection model: new prospects for vaccine development; Saukkonen K et al.; The protective efficacy of monoclonal antibodies to class 1 and class 3 outer membrane proteins of Neisseria meningitidis B:15:P1.16 was tested in an infant rat infection model . Four monoclonal antibodies to class 1 protein had bactericidal titres exceeding 20,000 and they protected infant rats completely against bacterial challenge with meningococci carrying the same class 1 protein, P1.16 . One monoclonal antibody to class 3 protein was highly bactericidal (titer greater than 20,000), whereas two others had no bactericidal activity . All these antibodies gave some protection from infection, resulting in mortalities varying from 66 to 83% as compared to 100% in control rats who had received either unrelated monoclonal antibody or saline . These results strongly speak for class 1 outer membrane protein as a vaccine candidate for meningococcus group B. Antimicrob Agents Chemother, 1987 Oct, 31(10), 1478 - 82 Detection of relatively penicillin G-resistant Neisseria meningitidis by disk susceptibility testing; Campos J et al.; Beginning in 1985, relatively penicillin G-resistant (Penr) meningococci which did not produce beta-lactamase were isolated from the blood and cerebrospinal fluid of patients in Spain . We identified 16 Penr (mean MIC, 0.3 microgram/ml; range, 0.1 to 0.7 microgram/ml) and 12 penicillin-susceptible (Pens; mean MIC, less than or equal to 0.06 microgram/ml) strains of Neisseria meningitidis by the agar dilution technique using an inoculum of 10(4) CFU and questioned which disk susceptibility test would best differentiate these two populations . We compared the disk susceptibility of these strains using disks containing 2 (P2) and 10 (P10) U of penicillin G, 2 (Am2) and 10 (Am10) micrograms of ampicillin, and 1 microgram of oxacillin (OX1) . We also investigated susceptibility with disks containing 30 micrograms of each of cephalothin (CF30), cefoxitin (FOX30), cefuroxime (CXM30), and cefotaxime (CTX30) and 75 micrograms of cefoperazone (CFP75) and determined by cluster analysis any correlation with the zone diameters obtained with P2 disks . Using the P2 and AM2 disks (in contrast to the P10 and AM10 disks), we correctly differentiated all the Penr from Pens isolates . In addition, the zone diameters with the P2 disk gave the best correlation with the penicillin G MIC determinations . All 16 Penr strains and 3 of 12 Pens strains showed zone diameters of 6 mm around OX1 disks, limiting the usefulness of OX1 disks . The zone diameters obtained with CF30, CXM30, and OX1 disks correlated with those obtained with the P2 disk, which suggests that these antibiotics have similar effects on these strains . In contrast, the data obtained with FOX30, CTX30, and CFP75 disks did not cluster with those obtained with the P2 disk, which suggests that there was a difference in the bacterial target or reflects their greater activity . We conclude that the P2 disk tests more readily identify Penr meningococci than do the standard P10 disk tests. Antibiot Med Biotekhnol, 1987 Oct, 32(10), 758 - 63 {Evaluation of the effectiveness of group-A and -C meningococcal polysaccharide vaccines by molecular parameters}; Bobyleva GV et al.; Chromatographic properties of meningococcal polysaccharides and vaccines of serogroups A and C prepared at the G . N . Gabrichevskii Moscow Research Institute of Epidemiology and Microbiology were studied during determination of their molecular parameters by gel filtration on sepharose 4B . It was shown that the character of the polysaccharide elution was not affected by the composition of the eluent and pH changes within the ranges of 6.5-8.5 . The ionic strength of the solvent should be at least 0.2 mol/l . Immunochemical methods such as countercurrent and rocket immunoelectrophoresis were standardized and recommended for quantitative evaluation of the content of meningococcal polysaccharides of groups A and C in the eluates . Rocket immunoelectrophoresis was shown to be more accurate and reproducible. Mol Immunol, 1987 Oct, 24(10), 1005 - 19 Bacterial capsular polysaccharides--biochemistry, immunity and vaccine; Lee CJ; The biochemical basis of immunogenicity to bacterial capsular polysaccharides (PSs) has been extensively studied . Antibody responses to PS antigens can be greatly affected by their physico-chemical properties, e.g . molecular size, specific determinants, conformation etc . At present, three bacterial PS vaccines, including meningococcal, pneumococcal, and H . influenzae type b, have been licensed in the U.S.A . Many other PSs, such as group B Streptococcus, Pseudomonas aeruginosa and Klebsiella, are still in various stages of vaccine development . Studies on the type distribution of pneumococcal isolates from Asian populations showed that the types included in the 23-valent pneumococcal vaccine were considerably fewer in Asia than that observed in the U.S.A.: the proportion of types was 62.9% in Taiwan, 72.9% in Japan and 87.9-92.8% in the U.S.A . A large number of pneumococcal types found in Taiwan and Japan, such as 15A, 23A, 24F and 34, are not present in the pneumococcal vaccine . Immunization with one type of group 9 or 19F PS induced a poor antibody response to the other type . All 9N, 9V, 19F and 19A PSs are required in the vaccine to induce sufficient antibodies against group 9 and 19 infection . Extensive cross-reactions have been found between pneumococcal PSs and PSs from other bacteria . Klebsiella K2 PS could enhance the magnitude of the antibody response to 19F PS . The structure of streptococcal 14636/74 was found to be identical to pneumococcal 19F PS . A difficult problem in the development of vaccines against bacterial diseases is the poor immune response of young children to purified PSs . Antibodies against the PSs can be elicited when PS antigens are conjugated to a protein carrier . In mice, the maternal immunization with pneumococcal PS during pregnancy or before mating, did not cause suppression or other observable harmful effect, rather it may provide sufficient antibodies for protection against infection during early life. Epidemiol Infect, 1987 Oct, 99(2), 463 - 9 Isolation of Neisseria meningitidis strains with increase of penicillin minimal inhibitory concentrations; Saez-Nieto JA et al.; We report the isolation and characterization of ten strains showing an increase in the minimal inhibitory concentrations to penicillin (MICs greater than 0.1 microgram/ml), and describe the epidemiological, clinical and microbiological features . The susceptibility of 3432 meningococcal strains isolated from patients in the recent epidemic wave (1978-86) in Spain, to several antimicrobial agents used in the treatment and chemoprophylaxis of meningococcal infection has been tested . Most were resistant to sulphadiazine but sensitive to other antibiotics . The possible existence of a new pattern of behaviour of meningococcal to penicillin is discussed. Eur J Pediatr, 1987 Sep, 146(5), 515 - 8 Childhood bacterial meningitis: initial symptoms and signs related to age, and reasons for consulting a physician; Valmari P et al.; The relationship of symptoms and signs to age and the reasons for consulting a physician were analyzed in 110 cases of culture-proven childhood bacterial meningitis . H . influenzae caused 74, meningococci 28, pneumococci 6 and streptococci 2 of the cases . Apart from fever (present in 94%), the most common symptoms according to age were as follows: 1-5 months: irritability (85%), 6-11 months: impaired consciousness (79%), 12 months or more: vomiting (82%) and neck rigidity (78%) . Absence of neck rigidity at diagnosis was associated with young age (less than 12 months, P less than 0.001) and, in older children, to a short duration of symptoms (P less than 0.01) but not to the degree of CSF pleocytosis . Symptoms of meningitis caused by H . influenzae differed from those of meningococcal meningitis . Meningitis should be suspected in irritable or lethargic febrile children despite absence of neck rigidity . Fever and vomiting were the most frequent reasons for consulting a physician (60% and 31%, respectively) . Despite the frequency and alarming character of irritability, impaired consciousness and neck rigidity, their presence led infrequently to a consultation (6%, 22% and 3%, respectively) . Parental ignorance of such symptoms or of their importance may cause treatment delay, despite readily available medical services. J Clin Lab Immunol, 1987 Sep, 24(1), 29 - 32 Lipopolysaccharide structure and serum sensitivity of non-serogroupable Neisseria meningitidis; Blackwell CC et al.; Bactericidal activities of normal human serum for non-serogroupable strains of Neisseria meningitidis were determined . In similar experiments with isolates of Neisseria gonorrhoeae from localized infections, strains with group I lipopolysaccharide (LPS) were uniformly serum resistant and those with group II were serum sensitive . We found no similar association between serum sensitivity of the meningococcal strains and their lipopolysaccharide groups determined by the same pyocin typing system used to classify the gonococcal isolates . Immune mouse sera raised against non-serogroupable meningococci of either LPS group I or II were bactericidal for non-serogroupable strains of the same LPS group and also cross-reactive for strains of the opposite group . They were not bactericidal for the majority (13/17) of the serogroupable strains tested . These findings suggest there are antigens, in addition to the LPS and capsules, that elicit some of the "natural" bactericidal antibodies to pathogenic meningococci. Infect Immun, 1987 Sep, 55(9), 2171 - 5 Effects of serum carrier proteins on the growth of pathogenic neisseriae with heme-bound iron; Dyer DW et al.; The pathogenic neisseriae can use free heme and hemoglobin as an essential source of iron (Fe) for growth in vitro, but it is unknown whether they can utilize heme bound to human hemopexin or to human serum albumin, or hemoglobin bound to haptoglobin . We found that neither Neisseria meningitidis nor Neisseria gonorrhoeae used bound heme, but bound hemoglobin was used as an Fe source by two meningococcal strains and one gonococcal strain . A second gonococcal strain, previously shown to use free hemoglobin poorly or not at all, also did not grow with hemoglobin-haptoglobin complex as an Fe source . These observations suggest that hemoglobin might act as an Fe source in vivo for many pathogenic neisseriae even when in complexed (bound) form, but heme probably would not support growth in vivo if bound to serum carrier proteins. Clin Pediatr (Phila), 1987 Sep, 26(9), 473 - 6 Meningococcal conjunctivitis in neonates; Kenny JF; Three neonates were admitted with purulent conjunctivitis, and an initial diagnosis of gonococcal ophthalmia was made because gram-negative diplococci were seen on gram stains of conjunctival exudates . Meningococci were grown from eye exudates of all three infants and from the blood of one . Since Neisseria species other than gonococci can sometimes cause neonatal ophthalmia, an etiologic diagnosis should not be made until microbiologic identification is complete . Before the results of definitive bacteriologic studies are known, care should be taken in discussing the cause of the infection with family members and in planning their medical management . Since systemic infections may occur in some infants with ophthalmia due to Neisseria species, blood and spinal fluid in addition to eye exudate cultures may be indicated, and patients should be managed with parenteral antibiotics. Scand J Immunol, 1987 Sep, 26(3), 213 - 21 Modulation of the immune system by Neisseria meningitidis; Melancon-Kaplan J et al.; The immunomodulatory potential of Neisseria meningitidis was investigated . Spleen cells from mice injected intraperitoneally with low to moderate doses of meningococci (10(4)-10(7)) were found to display enhanced responses to the mitogens lipopolysaccharide (LPS), phytohaemagglutinin (PHA), and concanavalin A (Con A) . In contrast, high doses of meningococci (10(8)-10(9)) caused a marked decrease in mitogenic reactivity . Meningococci-injected mice also displayed a dose-dependent suppression of a primary anti-sheep red blood cell (SRBC) plaque-forming cell (PFC) response . The timing between the injection of SRBC and of meningococci appeared to play an important role in the induction of suppression by the organisms . Thus, decreased PFC responses were observed only when the bacteria were injected prior to the antigen . When meningococci were injected at the same time or after SRBC, normal or even increased PFC responses developed . Kinetic experiments showed that the onset of suppression of both mitogen and antibody responses by meningococci was very rapid, so that by 6-7 h after injection of the bacteria, mice showed markedly reduced mitogen responses and became essentially unable to mount an antibody response against SRBC . Suppression of mitogen responses was relatively transient, since reactivity returned to normal after 48 h . However, the ability of infected animals to mount a normal anti-SRBC response did not fully return until 12 days after the infection . Spleen cells from meningococci-infected mice also showed markedly depressed PFC responses when stimulated with SRBC in vitro but failed to suppress the response of normal spleen cells in mixed cultures . These observations indicate that putative suppressor cells, if they exist at all, are too insignificant in terms of numbers and/or efficiency to account for the observed immunosuppression . A more likely explanation for the inhibition, which is supported by our data, presented here and elsewhere, is that certain surface components of meningococci are capable of imparting immunosuppressive signals directly onto target lymphocytes. Mol Microbiol, 1987 Sep, 1(2), 179 - 85 Localization of a conserved epitope and an azurin-like domain in the H.8 protein of pathogenic Neisseria; Kawula TH et al.; The pathogenic neisseriae, Neisseria gonorrhoeae and Neisseria meningitidis, possess an outer membrane protein, H.8, which contains a conserved monoclonal antibody (MAb)-binding epitope in all strains tested . We have cloned and sequenced a meningococcal H.8 gene, and determined the characteristics of the predicted protein . The predicted signal peptide has features characteristic of a prokaryotic lipoprotein . The region at the N-terminal end of the mature protein (39 amino acids) is primarily composed of alanine, glutamate and proline residues arranged in imperfect repeats with the consensus sequence AAEAP . The epitope for H.8 MAb-binding was localized to a 20-amino-acid sequence within this region . The remainder of the predicted amino acid sequence shows extensive homology to azurins, which are small blue copper-binding proteins found in a limited number of species of pathogenic bacteria. Psychiatr Neurol Med Psychol (Leipz), 1987 Aug, 39(8), 467 - 74 {Pathogen spectrum in bacterial meningitis in childhood and subsequent therapeutic strategy}; Wasser S et al.; In a total of 223 children over one month old suffering from purulent meningitis, there was a predominance (n = 96) of meningococci over hemophilus influenzae (n = 68) and pneumococci (n = 59) . Crucial to therapeutic strategy for purulent meningitis is early diagnosis, in our laboratory covering both liquor and blood cultures . Initial therapy has to take account of these three chief causal agents . We have not as yet observed any resistance to penicillin from meningococci or pneumococci, and none of the liquor-cultivated hemophilus influenzae stock has been resistant to ampicillin . In the first two years of life, initial therapy for bacterial meningitis should include ampicillin, a liberal (300-400 mg/kg KM/d) dosage continuing to be important after the onset of improvement . In view of the lack of resistance of the causal agents cultivated, we had hitherto no cell to deploy modern cephalosporins in cases of bacterial meningitis in children. Pediatr Res, 1987 Aug, 22(2), 123 - 9 Persistently circulating C3 nephritic factor (C3 NeF)-stabilized alternative pathway C3 convertase (C3 CoF) in serum of an 11-year-old girl with meningococcal septicemia--simultaneous occurrence with free C3 NeF; Wahn V et al.; Hemolytic complement was found to be absent in the serum of an 11-yr-old girl (R.N.) with meningococcal septicemia . C1, C4, and C2 were slightly decreased, C3 was absent, C5-C9 within the normal range . B levels immunochemically and electrophoretic mobility of B were normal . C3d was greater than 1000% of a pooled EDTA-plasma standard indicating hypercatabolism of C3 . On incubation of the patient's serum with normal human serum activation of C3 occurred even in the presence of 0.04 M EDTA . The amount of C3b generated was, however, greater without any chelating agent or in Mg-EGTA . On gel filtration of the serum two protein containing peaks were found to be responsible for activation of C3: the IgG containing peak was able to activate C3 in normal human serum without chelating agents and in Mg-EGTA but not in the presence of EDTA . The IgM-containing peak activated the third component of complement even in the presence of EDTA . The factor responsible for this phenomenon was termed C3 converting factor (C3 CoF) . The IgG fraction of the patients serum caused activation of C3 in Mg-EGTA . However, in the presence of EDTA no activation of C3 could be induced even if physiological concentrations of the patients IgG were added to normal human EDTA-plasma . Thus the activity of the patient's IgG did not differ from typical C3 nephritic factor . The decay of C2 in EAC42 intermediates in the presence of the patient's IgG was uninfluenced indicating that it did not carry autoantibody activity against the classical pathway convertase C4b,2a, an activity recently termed NFc.(ABSTRACT TRUNCATED AT 250 WORDS) Clin Immunol Immunopathol, 1987 Aug, 44(2), 134 - 9 Congenital properdin deficiency and meningococcal infection; Nielsen HE et al.; We report a family in which three males in two generations had meningococcal infections; one of them died . Hemolytic activity of the alternative complement pathway in the two survivors and in one healthy boy belonging to the family was reduced, as measured in a kinetic system . These three individuals had 10-11% of normal properdin concentration in plasma, as measured by a catching ELISA method, while the other complement components were normal . Hemolytic complement activity was normalized when purified properdin was added . The data are compatible with an X-linked mode of inheritance of properdin deficiency. Acta Pathol Microbiol Immunol Scand {C}, 1987 Aug, 95(4), 155 - 60 Standardization of a chemiluminescence method for the measurement of meningococcal opsonins using ethanol fixed meningococci; Halstensen A et al.; A chemiluminescence (CL) method using polymorphonuclear leukocytes (PMNLs) and an automatic photoluminometer was used to measure serum opsonins to viable and inactivated group B meningococci . Continuous mixing at 37 degrees C both during opsonization and phagocytosis was essential for optimal CL responses . The CL response increased rapidly during an opsonization time up to 7.5 min, and with PMNL and bacteria concentrations up to 37.5 X 10(5) and 3.8 X 10(7) cells/ml, respectively . Opsonized ethanol fixed meningococci gave CL responses similar to those of viable meningococci, but had a better reproducibility . Using the ethanol fixed bacteria, the variation of PMNLs from different donors, the day-to-day variation, and the coefficient of variation of the CL responses, were all less than 10% . The opsonic activity of convalescent sera from 10 patients with meningococcal disease was markedly higher than that of sera obtained during the acute phase of the disease . Thus, this standardized CL assay using ethanol fixed bacteria is a highly reproducible and sensitive method for measuring serum opsonins to meningococci. J Clin Microbiol, 1987 Aug, 25(8), 1546 - 7 Organism resembling Neisseria gonorrhoeae and Neisseria meningitidis; Hodge DS et al.; A problem isolate resembling Neisseria gonorrhoeae and Neisseria meningitidis is reported . Growth and biochemical characteristics indicated the organism to be N . meningitidis, whereas serological characteristics indicated it to be N . gonorrhoeae . This vaginal isolate may be a genetically transformed gonococcus with the ability to utilize maltose . Conversely, it may be a meningococcus which has acquired antigenic determinants of N . gonorrhoeae. J Clin Microbiol, 1987 Aug, 25(8), 1349 - 53 Human immunoglobulin G subclass immune response to outer membrane antigens in meningococcal group B vaccine; Wedege E et al.; The immunoglobulin G (IgG) subclass distribution of antibodies against the major outer membrane proteins from serotype 2a Neisseria meningitidis in human vaccinees was studied by immunoblotting . The volunteers received two doses of a noncovalent complex of group B polysaccharide and outer membrane material from the same meningococcal strain . Six weeks after the first vaccination the antibodies mounted against the class 1 and 5 proteins belonged mainly to the IgG1 and IgG3 subclasses . However, the binding of IgG3 to the class 5 proteins decreased markedly in serum samples taken after 25 weeks . Antibody binding to the serotype-specific class 2 protein was dependent on renaturation of the antigen by a dipolar ionic detergent (R . E . Mandrell and W . D . Zollinger, J . Immunol . Methods 67:1-11, 1984) . The immune response against this protein showed more individual variation and consisted of IgG1 or IgG3 or both, often combined with IgG4. Infect Immun, 1987 Aug, 55(8), 1927 - 8 Resistance to meningococcemia apparently conferred by anti-H.8 monoclonal antibody is due to contaminating endotoxin and not to specific immunoprotection; Woods JP et al.; We evaluated the ability of a monoclonal antibody directed against the common H.8 antigen of pathogenic Neisseria sp . to confer passive protection against meningococcal disease in mice . The apparent protection conferred by antibody purified from tissue culture supernatant was actually the result of endotoxin contamination of buffers and tissue culture media . Endotoxin-free anti-H.8 antibody was not protective . The possibility of endotoxin contamination should be considered when evaluating immunity conferred by passively administered antibody in animal models. Genitourin Med, 1987 Aug, 63(4), 250 - 5 Indirect haemagglutination test using gonococcal pilus antigen: how useful to diagnose gonorrhoea? Reimann K, Odum L, Larsen SO, Lind I. In 1979 an indirect haemagglutination test (gonococcal antibody test) using gonococcal pilus antigen replaced the gonococcal complement fixation test as our routine procedure to show gonococcal antibodies . In the diagnosis of current gonorrhoea the sensitivity of the gonococcal antibody test was far superior to that of the gonococcal complement fixation test (about 55% versus 9% for first episode gonorrhoea) . To evaluate the usefulness of the test result the following population groups were studied: 1376 patients undergoing medical examination for gonorrhoea (386 had gonorrhoea), 1384 healthy people aged 15-65, 54 patients with meningococcal disease, 30 children with respiratory tract infection, and 254 patients with evidence of various diseases other than neisserial infections that might be associated with symptoms of arthritis . These investigations showed that (1) non-specific positive gonococcal antibody test results occur rarely, (2) at least half the people who have had gonorrhoea remain seropositive (with titres of 1/40 to 1/160), and (3) a positive test result is more significant the younger the patient and the higher the titre . For younger people a positive test result should always be followed up by bacteriological examination; in all age groups titres of 1/320 or more should indicate medical examination for current gonorrhoea. Pediatrics, 1987 Jul, 80(1), 63 - 7 Neisseria meningitidis bacteremia in children: quantitation of bacteremia and spontaneous clinical recovery without antibiotic therapy; Sullivan TD et al.; The relationship between the magnitude of bacteremia due to Neisseria meningitidis and the clinical diagnosis was determined for 43 children who had fever in the presence or absence of focal signs of infection . Bacteremia was quantitated by the previously described procedure using heparinized blood (0.2 to 1.0 mL) . Additionally, blood was cultured by means of the radiometric Bactec technique . Seventeen patients had meningitis, 12 had meningococcemia, 13 had unsuspected or "occult" bacteremia, and five had other diagnoses . "Occult" bacteremia was diagnosed initially in four patients, but subsequently meningitis was diagnosed . All 13 patients with 500 or more organisms per milliliter had meningitis or meningococcemia in contrast to 12 (55%) of 22 patients with less than 500 organisms per milliliter (P less than or equal to .0035) . Only 18 (42%) of these patients bacteremic with N meningitidis presented with petechiae or purpura . All 13 children with occult bacteremia were sent home after blood cultures were obtained; six of the 13 received a regimen of oral amoxicillin for otitis media . At reexamination (interval 16 to 119 hours) four had meningitis, seven were clinically improved (afebrile, negative blood culture, without invasive disease), and two were still mildly febrile with negative blood culture . Three of these bacteremic children experienced spontaneous clinical and bacteriologic resolution without antibiotic treatment . This has not been previously reported. J Infect Dis, 1987 Jul, 156(1), 107 - 12 Bactericidal activity for Neisseria meningitidis in properdin-deficient sera; Soderstrom C et al.; We investigated serum bactericidal reactions against Neisseria meningitidis (serogroups A, B, C, D, Y, W-135, 29E, X, and Z) in the sera of two healthy adults with properdin deficiency . Bactericidal reactions mediated via the classic complement pathway (unchelated system) were not impaired in properdin-deficient serum . The properdin-deficient sera supported alternative pathway-mediated killing (Mg++EGTA-chelated system) of some, but not all, of the strains investigated . Vaccination of the properdin-deficient individuals with serogroup A and C polysaccharide clearly increased the concentrations of antibody to meningococci . At least some of the antibodies induced by vaccination supported the bactericidal activity of properdin-deficient serum . Some antibodies to meningococci, probably of the IgM class, promoted alternative pathway-mediated bactericidal reactions in the absence of properdin . By contrast, presensitizing meningococci with IgG enhanced the alternative pathway-mediated reactions, but this was strictly a properdin-dependent effect. Zh Mikrobiol Epidemiol Immunobiol, 1987 Jul, (7), 49 - 53 {Antibody response to capsular polysaccharide antigen in an infection caused by meningococcus serogroup B in children}; Kostiukova NN et al.; The continuous synchronous cultivation of serogroup B meningococci and the use of the selected clones of producer strains has made it possible to obtain the serologically active preparation of the group-specific antigen from the culture in the exponential phase . The erythrocyte diagnosticum produced on the basis of this preparation has permitted the detection of group-specific antibodies in the sera of immunized rabbits and children with generalized infection caused by serogroup B meningococci . The intensity of immune response depends on the age of children . This new technique of the passive hemagglutination test is recommended for the confirmation of generalized infection caused by serogroup B meningococci. J Clin Microbiol, 1987 Jul, 25(7), 1155 - 8 Antigens that are similar in apparent molecular weight to gonococcal outer membrane protein III; Barrera O et al.; Two immunoglobulin G monoclonal antibodies (MAbs) were produced by using purified outer membranes and whole gonococci as immunogens . These MAbs recognized antigens with similar apparent sizes (30 to 31.5 kilodaltons {kDa}) in several pathogenic and nonpathogenic neisseriae . In gonococci, these 30- to 31.5-kDa components, although similar in subunit size to outer membrane protein III (P.III), are distinct due to their differences in electrophoretic migration-modification by 2-mercaptoethanol and their cellular location . The two 30- to 31.5-kDa moieties are denoted by MAb2 and MAb3, respectively, by which they are identified . The differentiating characteristic of these three antigens (P.III, MAb2, MAb3) is their change or lack of change in electrophoretic mobility in the presence versus absence of 2-mercaptoethanol; P.III migrates less rapidly, MAb2 does not change, and MAb3 migrates more rapidly . Both the epitopes that were reactive with MAb2 and MAb3 were resistant to proteolytic treatment of intact gonococci; neither epitope was detected on whole, unfixed gonococci by immunofluorescence . Both MAb2 and MAb3 epitopes were represented uniformly among pathogenic neisseriae (except group Z meningococci) and less regularly among nonpathogenic neisseriae. J Immunol, 1987 Jun 15, 138(12), 4402 - 7 An IgG monoclonal antibody to group B meningococci cross-reacts with developmentally regulated polysialic acid units of glycoproteins in neural and extraneural tissues; Finne J et al.; The structurally similar polysialic acid capsules of group B meningococci and Escherichia coli K1 are poor immunogens, and attempts are currently being made to improve their immunogenicity by chemical modifications . An IgG monoclonal antibody to these polysialic acid capsules was used for the study of the presence of structurally similar components in tissue glycoproteins to investigate the reasons for the poor immunogenicity and to evaluate potential dangers in active or passive immunization . By immunoblotting polysialic acid was detected outside the brain in newborn rat kidney, heart, and muscle . It appeared in immunoblots as one component and with similar mobility to the neural cell adhesion molecule N-CAM . Specificity studies of the antibody and endosialidase treatment showed that the polysialic acid glycans detected were composed of chains as long as eight sialic acid residues or more . The polysialic acid was not detected in the corresponding tissues of the adult animal . These results indicate that polysialic acid units are developmentally regulated components of both neural and extraneural tissues, and are bound to components with properties similar to a known cell-adhesion molecule . This together with the presence of low amounts of polysialic acid even in the adult brain, suggests potential hazards in vaccination trials and suggested immunotherapy of meningitis caused by group B meningococci or E . coli K1, which should be carefully assessed. Biull Eksp Biol Med, 1987 Jun, 103(6), 672 - 5 {Lipid peroxidation and hyperfermentemia in bacterial lesions of the CNS}; Roslyi IM et al.; It was found that the increase in the serum level of lipid peroxidation products in patients with meningococcal meningitis correlated with the severity of the disease . The dependence between the level of lipid peroxidation products and the activity of cell enzymes in the serum has been investigated . During the first day of the disease GOT activity was strongly increased, while the level of lipid peroxidation products was 1560 +/- 237 mumol/l, which may be of a diagnostic value. Eur J Clin Invest, 1987 Jun, 17(3), 226 - 30 Bactericidal capacity against Neisseria meningitidis of normal human serum and sera with functional deficiencies of the third and eight complement factor; Strate M et al.; The bactericidal capacity of serum with C3 deficiency secondary to circulating C3 nephritic factor, serum with C8 deficiency and normal human serum were assessed in vitro against Neisseria meningitidis groups A-C . Normal human serum and C8-deficient serum, originating from a 28-year-old male with two episodes of meningococcal meningitis, showed significant bactericidal capacity against meningococci groups A and B . Against group C meningococci the C8-deficient serum revealed significant bactericidal capacity, whereas normal human serum showed no bactericidal effect . Serum with C3 deficiency, obtained from a 16-year-old female with two episodes of meningococaemia, showed no bactericial effect against meningococci groups A-C . Incubation of normal human serum and C8-deficient serum with isolated nephritic factor resulted in C3 depletion and abolished the bactericidal effect. Antimicrob Agents Chemother, 1987 Jun, 31(6), 962 - 3 Effect of ciprofloxacin on carrier rate of Neisseria meningitidis in army recruits in Finland; Renkonen OV et al.; The efficacy of ciprofloxacin in eradicating pharyngeal colonization of Neisseria meningitidis was studied among army recruits in Finland . Ciprofloxacin (250 mg) or placebo was given twice a day for 2 days to 118 meningococcal carriers . Meningococcal carriage was eradicated in 96% of subjects given ciprofloxacin and in 13% of those given placebos. Am J Med, 1987 Jun, 82(6), 1257 - 8 Multiple myeloma presenting with primary meningococcal arthritis; Miller MI et al.; A 64-year-old white man presented with Neisseria meningitidis primary septic arthritis . Further evaluation revealed multiple myeloma . Increased susceptibility to infection occurs early in multiple myeloma; thus, a rare cause of primary septic arthritis, such as N . meningitidis, warrants a full evaluation for immunocompromise. J Infect Dis, 1987 Jun, 155(6), 1266 - 75 Killing of Neisseria meningitidis by human neutrophils: implications for normal and complement-deficient individuals; Ross SC et al.; The contributions of complement-dependent phagocytosis and serum bactericidal activity (SBA) to the killing of 62 strains of meningococci were examined by using C8-depleted or pooled human serum (PHS) . The complement-dependent nature of killing by neutrophils was confirmed by restoring survival to control values by using heated serum . Serogroups B and 29E, but not A, C, Y, and W135, were ingested and killed by neutrophils in C8-depleted PHS (PHS-C8Dep; 41.7% +/- 7.3% and 60.5% +/- 17.8% vs . greater than or equal to 100% survival, respectively, at 30 min) . Group B meningococci were resistant to complement-mediated SBA, whereas group Y were susceptible . Deposition of C3 on serogroups B and Y was similar (28.5 +/- 2.9 vs . 23.5 +/- 2.7 C3 fluorescence units; P greater than .05); however, susceptibility to complement-dependent phagocytosis and complement-mediated SBA of serogroups B and Y did not correlate . We also examined meningococcal phagocytosis by using serum from a C8-deficient patient . In contrast to PHS-C8Dep, this serum supported rapid phagocytic killing of serogroups A, C, Y, and W135 meningococci . This finding suggests that vaccinating individuals deficient in late-complement components may shift the burden of host defense from SBA to phagocytosis. Zh Mikrobiol Epidemiol Immunobiol, 1987 Jun, (6), 29 - 33 {Epidemiological characteristics of meningococcal infection in a number of territories of the RSFSR (1969-1984)}; Mukhina LP et al.; In this work the dynamics and morbidity level in respect of meningococcal infection at 11 territories of the RSFSR at the period of 1969-1984 are analyzed . The study covered altogether 16 cities and 211 districts . The role of big cities as the sources of infection spreading into rural areas and further "fixation" of this infection mainly in regions with a population of 60,000 and more had been established . The data on meningococcal morbidity and carriership among different age groups are presented . The study has shown a pronounced increase in the incidence rate of meningococcal infection among children aged up to 2 years, as well as an increase in the proportion of these children among patients with meningococcal infection in recent years. J Gen Microbiol, 1987 Jun, 133 ( Pt 6), 1409 - 18 Inter-strain homology of pilin gene sequences in Neisseria meningitidis isolates that express markedly different antigenic pilus types; Perry AC et al.; Neisseria meningitidis isolates examined in this study elaborated one of two pilus types that were antigenically markedly different . Each pilus type reacted either with SM1, a monoclonal antibody that recognizes an epitope common to all gonococcal pili, or with a polyclonal antiserum raised against meningococcal pili that did not react with SM1, but not both . Total genomic DNA from all N . meningitidis isolates analysed, irrespective of pilus type, contained at least one region with extensive homology to a gonococcal pilE probe . Different N . meningitidis strains possessed one of several configurations of genomic pilE-homologous segments . Chromosomal rearrangement of pilE-homologous sequences was associated with P+ to P- pilus phase transition in the strains examined . The arrangement of pilE-homologous segments in total genomic DNA from N . meningitidis isolated from the blood and cerebro-spinal fluid of the same patient was apparently identical. Clin Exp Immunol, 1987 May, 68(2), 437 - 45 Screening for complement deficiencies in unselected patients with meningitis; Rasmussen JM et al.; Two hundred and nine patients consecutively admitted to hospital with a tentative diagnosis of meningitis were screened for complement deficiency by measuring classical and alternative pathway serum haemolytic complement activity and the plasma concentration of C3d . Abnormal test results were followed up by quantitative immunochemical measurements of individual complement components . No patients with homozygous complement deficiency were found in our material . One patient with pneumococcal meningitis with probable heterozygous C2-deficiency was identified . Patients with purulent meningitis of various etiologies or meningococcal disease had significantly increased plasma C3d concentration at admission compared to patients with serous meningitis or without meningitis . Furthermore, increased plasma level of C3d at admission in patients with purulent meningitis or meningococcal disease was associated with an increased lethality . Our findings do not support the hypothesis that complement deficiency is commonly associated with sporadically occurring meningococcal disease or purulent meningitis. Pathol Biol (Paris), 1987 May, 35(5), 624 - 5 {Antibioprophylaxis of Meningococcus group B meningitis . Must we implicate the use of the spiramycin}; Garre M et al.; A fatal meningitis due to a spiramycin-sensitive group B Neisseria meningitidis occurred 13 days after interruption of a prophylactic antimicrobial therapy with spiramycin . The efficacy of recommended antimicrobial preventive treatment is discussed with regard to this case, other published cases and to the known partial and short term eradication of the naso-pharyngeal carriage of Neisseria meningitidis. Zh Mikrobiol Epidemiol Immunobiol, 1987 May, (5), 54 - 8 {Safety, reactogenicity and immunological activity of a group A meningococcal polysaccharide vaccine for children 1-4 years old}; Chernyshova TF et al.; In the controlled trial carried out among children aged 1-4 years, the safety, reactogenicity and immunological potency of group A meningococcal polysaccharide vaccine produced at the Gabrichevskii Research Institute of Epidemiology and Microbiology (Moscow) were studied . The vaccine under test was introduced in two doses containing 15 and 25 micrograms of meningococcal polysaccharide . Both doses were shown to be safe, faintly reactogenic and immunologically potent . Systemic reactions were manifested by a transient rise in temperature to subfebrile levels in 19% and to 37.8-38.2 degrees C in 4.7% of the vaccinees . The temperature dropped to the normal level by the end of the first day following vaccination . At the site of injection skin hyperemia up to 2-3 cm in diameter was registered in 74% and up to 5-6 cm in diameter, in 6% of the vaccinees . Hyperemia disappeared on day 2 after vaccination . The production of antibodies to group A meningococcal polysaccharide occurred in response to both doses under test, and the elevated antibody level (in comparison to the initial one) was retained perceptibly longer in response to a dose of 25 micrograms; this dose, considering its low reactogenicity, was chosen as the optimal dose for children of the above age group. Zh Mikrobiol Epidemiol Immunobiol, 1987 May, (5), 36 - 40 {Meningococcal serogroup B infection}; Pokrovskii VI et al.; The results obtained in the examination of patients with meningococcal infection during the period of 1980-1985 are analyzed . The increasing role of serogroup B meningococci in the etiology of the generalized forms of infection, especially in children aged under 3 years and in adults over 50 years, is shown . As noted in this investigation, the disease induced by group B meningococci runs a more severe course . Morbidity caused by this serogroup of meningococci does not result in epidemics in our country . The distribution of patients among different age groups and specific features of the clinical course of the disease in connection with the serogroup of the causative agent make it possible to regard the risk groups as groups with decreased reactivity, which raises doubts concerning the possibility of forming effective postvaccinal immunity against group B meningococci in such persons. J Clin Lab Immunol, 1987 May, 23(1), 53 - 6 Recurrent meningococcal meningitis associated with deficiencies of C8 and anti-meningococcal antibody; Cooke RP et al.; A patient with fatal recurrent meningococcal meningitis is described . Detailed complement and immunological investigation revealed a combined deficiency of C8 and anti-meningococcal antibody . An inability to make anti-meningococcal antibody in C8 deficient patients has not been previously reported. Pediatr Infect Dis J, 1987 May, 6(5), 438 - 9 Neisseria meningitidis strains with decreased susceptibility to penicillin; Van Esso D et al.; Neisseria meningitidis strains relatively resistant to penicillin were recovered from blood or cerebrospinal fluid cultures of four children treated in Barcelona, Spain, and surrounding areas . The four strains had distinct serogrouping and serotyping patterns . The minimal inhibitory concentrations of penicillin were 0.25 microgram/ml for three strains and 0.5 microgram/ml for the fourth strain . These are the first relatively penicillin-resistant meningococcal strains identified in Spain. Q J Med, 1987 Apr, 63(240), 349 - 58 Hereditary complement deficiency in survivors of meningococcal disease: high prevalence of C7/C8 deficiency in Sephardic (Moroccan) Jews; Zimran A et al.; The prevalence of complement deficiency was studied among 111 survivors of sporadic meningococcal disease located through the medical records of 10 Israeli hospitals . There were 11 patients with CH50 = 0: one with systemic lupus erythematosus and 10 with hereditary terminal complement deficiency (four with homozygous C7 and six with C8 deficiency) . There was no hereditary complement deficiency among 39 Ashkenazi subjects as against 18 per cent among 38 Sephardi subjects and 40 per cent among 15 of Moroccan ancestry (p less than 0.05) . The age at first presentation of meningococcal disease in complement deficient patients was 14.7 +/- 7.6, years compared with 8.1 +/- 10.9 in the non-deficient patients (p less than 0.025) . None of the complement deficient patients had meningitis below the age of 5 years vs . 49 per cent of non-deficient subjects . Recurrent meningitis was observed in 40 vs . 4 per cent (p less than 0.01) and meningitis in siblings in 40 vs . 2 per cent respectively (p less than 0.001) . In addition to the 10 propositi, 11 non-propositus siblings were identified with severe complement deficiency (six with homozygous C7 and five with C8 deficiency) . Seven of the non-propositi had no history at all of meningitis or any other serious systemic disease, underlining the relatively favourable prognosis of terminal complement deficiency . With increasing familiarity with the clinical features of this hereditary disease, it is possible now to identify on clinical grounds patients with meningococcal disease with a high likelihood of terminal complement deficiency. J Trop Med Hyg, 1987 Apr, 90(2), 95 - 6 Meningococcal hepatitis: a case report; Cowan GO; A case of meningococcal septicaemia is described in which the clinical presentation resembled that of viral hepatitis, and which responded rapidly to treatment with penicillin. J Exp Med, 1987 Apr 1, 165(4), 1041 - 57 Purification and characterization of the major iron-regulated protein expressed by pathogenic Neisseriae; Mietzner TA et al.; This report describes a method to purify the major iron-regulated protein (MIRP) expressed by N . gonorrhoeae and N . meningitidis . This purification procedure involves maximal expression of the MIRP by growing the organisms on iron-limited media; cellular disruption by sonication followed by centrifugal fractionation; selective solubilization of the MIRP with the cationic detergent hexadecyltrimethylammonium bromide; cation-exchange chromatography in the presence of this detergent; and gel filtration chromatography . The MIRP purified by this technique migrates as a single band when analyzed by SDS-PAGE . The purified MIRP displayed an unusually basic isoelectric point, this value being greater than 9.35 . Further biochemical analysis revealed the highly conserved nature of this protein isolated from the two pathogenic species of the genus Neisseria . For example, the amino acid composition of the meningococcal and gonococcal MIRPs were nearly identical and amino terminal sequence analysis showed that both shared the identical primary sequence through residue 48 . Surprisingly, the first five NH2-terminal residues of the MIRPs exhibited homology with the first five residues of the gonococcal porin, protein I . Purified preparations of the MIRP exhibited a characteristic pink color reminiscent of the basic iron-binding protein lactoferrin . This observation coupled with the property of iron-regulation prompted us to analyze purified MIRP for iron-content . Approximately 0.5 mol iron per 1 mol of MIRP was detected . This study is the first to show that iron is associated with the MIRP, a property that may implicate this protein as playing a direct role in neisserial iron assimilation . While the precise function of the MIRP is not known, the availability of this protein in pure and biologically relevant quantities will allow further studies to elucidate its pathobiologic function. Zh Mikrobiol Epidemiol Immunobiol, 1987 Apr, (4), 27 - 32 {A common meningococcaL intergroup antigen: immunological and immunochemical study}; Kostiukova NN et al.; Protein-containing preparations forming 1 precipitation line in highly sensitive immunoelectrophoretic tests have been obtained from the culture fluid of meningococci, groups A, C and X . The preparations have been found to render a very high degree of protection to mice challenged with meningococci of the homologous serogroup and a sufficiently high degree of protection to those challenged with meningococci of the heterologous serogroups . After the repeated injection of the preparations the appearance of the booster effect has been registered . Immunochemical study has shown that the preparation is a stable complex consisting of protein, group-specific polysaccharide and a heat-resistant component common for serogroups A, C, X and Y. J Clin Pathol, 1987 Apr, 40(4), 361 - 7 Opsonisation and phagocytosis of group B meningococci by polymorphonuclear leucocytes: comparison of sulphonamide sensitive and resistant strains; Ward KN et al.; A large proportion of disease caused by sulphonamide resistant strains of group B type 15 meningococci affects patients 10-24 years . In contrast, disease caused by sulphonamide sensitive strains conforms to the usual pattern, and most infection occurs in early childhood . In an attempt to explain this phenomenon possible differences in susceptibility of resistant and sensitive strains to phagocytosis by polymorphonuclear leucocytes were investigated, using radioactively labelled bacteria . In initial experiments a group B resistant strain required higher concentrations of normal human serum and longer opsonisation times for phagocytosis than an ungroupable non-pathogenic meningococcus . Comparison of sulphonamide resistant and sensitive group B meningococci showed that with either heat inactivated serum or agammaglobulinaemic serum, phagocytosis did not occur with any of the strains, whereas if these two sera were used together, phagocytosis was restored to the level seen with normal human serum . Thus both antibody and complement are required for phagocytosis . Furthermore, opsonisation depended on an intact classical pathway of complement for each group B strain . In all the experiments there was no significant difference between the phagocytosis of sulphonamide sensitive and resistant group B strains neither with regard to the efficiency of opsonisation by normal human serum nor the exact requirements for antibody and complement. J Exp Med, 1987 Apr 1, 165(4), 1207 - 11 N-propionylated group B meningococcal polysaccharide mimics a unique epitope on group B Neisseria meningitidis; Jennings HJ et al.; Antibodies induced in mice by the N-propionyl (N-Pr)-group B meningococcal polysaccharide (GBMP)-tetanus toxoid (TT) conjugate were bactericidal for GBM organisms independent of protein serotype . The antisera contained two populations of N-Pr-GBMP-specific antibodies, only one of which crossreacted with the GBMP . Particularly significant was the fact that the bactericidal activity was mainly associated with the population of antibodies that did not crossreact with the GBMP . Therefore it can be inferred from the above evidence that the N-Pr-GBMP mimics a unique epitope on the surface of GBM organisms that is not present on the exogenous GBMP. Presse Med, 1987 Mar 28, 16(11), 519 - 22 {Myocardial incompetence in meningococcal purpura in children . Early hemodynamic study}; Berthier JC et al.; In order to investigate the haemodynamic changes involved at the very beginning of meningococcal purpura fulminans, a prospective study was conducted in 10 children in whom a Swan-Ganz catheter was introduced on admission into the pulmonary artery . The first measurements performed 6 to 14 hours (mean: 10.2h) after the first signs of purpura were detected showed in every case a state of shock with fall in tissue oxygen consumption values and reduction of ventricular performance, although the systemic blood pressure was preserved and the central venous pressure was normal . In patients admitted at an early stage, 4 to 6 hours after the onset and directly from home, hypovolaemia predominated and masked the myocardial insufficiency . Patients referred by another hospital and whose hypovolaemia had already been corrected (i.e . 9 to 12 h after the onset) had full myocardial incompetence with fall in cardiac index, rise in capillary pressure and lowering of the ventricular function curve . Under beta-adrenergic stimulants combined with re-expansion of blood volume according to haemodynamic variations, the state of shock was reversed within 48 to 72 hours, and all patients in this series survived . These findings confirm that myocardial incompetence is constant and occurs at an early stage of purpura fulminans. Am J Med, 1987 Mar 23, 82(3 Spec No), 641 - 4 Myopericarditis as an initial presentation of meningococcemia . Unusual manifestation of infection with serotype W135; Brasier AR et al.; Acute meningococcemia is a dramatic clinical syndrome from infection with the gram-negative diplococcus, Neisseria meningitidis . Although pericarditis may complicate the course of meningococcemia, it is distinctly unusual as a presenting sign . A case of disseminated meningococcemia presenting as acute myopericarditis is reported . The serotype isolated, type W135, was a sporadic cause of N . meningitidis in the Boston area . Although the patient had meningitis, bacteremia, and myopericarditis, his course was uncomplicated with early institution of antibiotic therapy. Int J Epidemiol, 1987 Mar, 16(1), 91 - 7 Control of epidemic group A meningococcal meningitis in Nepal; Cochi SL et al.; During the first six months of 1983, an epidemic of serogroup A meningococcal meningitis occurred in the Kathmandu valley of Nepal, resulting in 875 cases and 95 deaths . The annual attack rate was 103 cases per 100,000 population, with a peak attack rate occurring in April . Epidemic meningococcal disease had not been recognized previously in Nepal . Early in 1984, a review of hospital-based data on pyogenic meningitis in Kathmandu showed three times as many cases per month compared with the same period the previous year, suggesting that a recurrent epidemic was unfolding . Beginning in February 1984, a vaccination campaign directed at a high-risk target population of people aged 1-24 years was launched; over 329,000 doses of bivalent A/C meningococcal vaccine were given, achieving approximately 64% coverage of the target population . A dramatic decline in the number of new meningitis cases occurred coincident with the initiation of the mass vaccination campaign . This experience demonstrates that it is possible, with appropriate surveillance efforts, to detect an evolving epidemic of meningococcal disease early in its course and to institute control measures in advance of the expected epidemic peak. Infection, 1987 Mar-Apr, 15(2), 109 - 10 Meningococcal pericarditis in the absence of meningitis; van Dorp WT et al.; A 16 year-old female presented with cardiac tamponade due to purulent meningococcal pericarditis without concomitant meningitis or meningococcaemia . She recovered after aspiration of the pericardial effusion and administration of a high dose of benzylpenicillin via a continuous infusion. Vaccine, 1987 Mar, 5(1), 11 - 26 An integrated molecular and immunological approach towards a meningococcal group B vaccine; Lifely MR et al.; There has been a notable lack of success in producing an effective vaccine against Neisseria meningitidis group B infections, despite such prophylaxis being available for group A and C disease . The reasons for this are reviewed and evidence presented that a vaccine based on the group B capsular polysaccharide should be pursued . To be effective, a clear understanding of, and improvement in the poor immunogenicity of the polysaccharide is required . Consequently, the nature of the antigenic structure involved in immune recognition has been evaluated at the molecular level and reasons for the poor immunogenicity of the B polysaccharide are presented . Methods of increasing the immunogenicity are proposed with the intention of undertaking human volunteer trials. J Infect, 1987 Mar, 14(2), 167 - 84 Factors influencing susceptibility to meningococcal disease during an epidemic in The Gambia, West Africa; Greenwood BM et al.; A study was made of factors that influenced susceptibility to group A meningococcal disease during an epidemic that affected The Gambia, West Africa during the dry season of 1982-83 . No explanations were found for the distribution of cases between villages or within affected villages . Socio-economic status, crowding, nutrition and previous exposure to meningococcal disease all appeared to be unimportant . Examination of serum samples obtained before the outbreak from a few children who subsequently became patients and from an equal number of age-matched controls from the same village showed a higher mean serum IgA value in children who became patients than in controls . There were not, however, any significant differences found in the concentrations of IgG, IgM, complement or meningococcal antibody between the two groups . Four children who developed culture-proven group A meningococcal disease had raised titres of bactericidal antibody to the epidemic strain 2-3 months before their illnesses . Our findings suggest that some important risk factors for group A meningococcal disease remain to be identified. Ann Trop Paediatr, 1987 Mar, 7(1), 47 - 53 Group B meningococcal infection in children during an epidemic in Cape Town, South Africa; Ryder CS et al.; One hundred and thirteen children with meningococcal infection were studied during an epidemic caused by N . meningitidis group B . Fifteen per cent presented with only meningeal symptoms, the remainder showed signs of septicaemia or combined septicaemia and meningitis . Sixteen per cent of the children were in shock and 18% required admission to the Intensive Care Unit (ICU) . The mortality was 4.4% . More than half the children were younger than 2 years old . There was no statistical association between the age or nutritional state of the children and any of our measures of severity . A short history of symptoms was more common in children who presented with septicaemia and severe illness, who needed admission to the ICU, or who died . Diagnosis was confirmed by routine bacteriological methods and counter-immuno-electrophoresis (CIE) in 104 children . Eighty-six per cent of the isolates were group B type 2 . A history of recent antibiotic treatment was associated with fewer positive cultures, but detection of meningococcal antigen by CIE was not affected by this . CIE antigen detection was not reliable because of the high incidence of false-negative results. Lancet, 1987 Feb 14, 1(8529), 355 - 7 Association between tumour necrosis factor in serum and fatal outcome in patients with meningococcal disease; Waage A et al.; Serum samples taken on admission from 79 patients with meningococcal meningitis, septicaemia, or both, were examined in a highly sensitive bioassay for tumour necrosis factor (TNF) . TNF was detected in samples from 10 of 11 patients who died but from only 8 of 68 survivors . All 5 patients with serum TNF levels over 440 units/ml (corresponding to 0.1 ng/ml recombinant TNF) died. J Clin Microbiol, 1987 Feb, 25(2), 203 - 6 API QuadFERM+ with rapid DNase for identification of Neisseria spp . and Branhamella catarrhalis; Janda WM et al.; The QuadFERM+ system (Analytab Products, Plainview, N.Y.), a 2-h carbohydrate degradation method for the identification of Neisseria spp., was evaluated along with a rapid DNase test for confirmation of Branhamella catarrhalis . QuadFERM+ identified 100% of 82 N . gonorrhoeae and 96% of 54 N . meningitidis strains . The two misidentified meningococcal strains were biochemically atypical and were also misidentified by the conventional method . Of 26 N . lactamica strains, 25 (96%) were correctly identified . Of 21 Neisseria spp., 14 (67%) produced carbohydrate reactions in agreement with the conventional procedure, and 7 strains produced detectable acid in the QuadFERM+ from maltose and sucrose but not glucose . All 9 N . cinerea and 30 B . catarrhalis strains were asaccharolytic by QuadFERM+ . The rapid DNase test was positive for all B . catarrhalis strains and negative for all other organisms . Two beta-lactamase-positive N . gonorrhoeae strains and 25 (93%) of 27 beta-lactamase-positive B . catarrhalis strains were detected by the 2-h acidometric beta-lactamase test on the strip . QuadFERM+ with rapid DNase is a simple and easily interpretable method for identification of these organisms in the clinical laboratory. Arch Intern Med, 1987 Feb, 147(2), 281 - 3 The acute arthritis-dermatitis syndrome . The changing importance of Neisseria gonorrhoeae and Neisseria meningitidis; Rompalo AM et al.; Sexually active young adults with an acute arthralgia or arthritis, with or without associated skin lesions, often have disseminated gonococcal infection (DGI) . In recent years, an increasing proportion of patients seen with such complaints at the University of Washington Hospitals, Seattle, have had systemic meningococcal infection rather than DGI . Among 151 patients with acute arthritis studied prospectively from 1970 to 1972, blood or synovial fluid cultures yielded Neisseria gonorrhoeae in 30 patients and Neisseria meningitidis in two . Among 62 patients meeting the same criteria who were studied prospectively from 1980 to 1983, blood or synovial fluid cultures yielded gonococci in nine and meningococci in five . Separate analysis of blood culture results from two University of Washington Hospitals also revealed a decline in the number of cases of gonococcemia from 1970 through 1984 and a shift in the relative numbers of patients with bacteremia due to N gonorrhoeae and N meningitidis . The observed decline in gonococcemia coincides with a decline in the proportion of gonorrhea in Seattle caused by gonococcal strains that have been associated with DGI. J Infect Dis, 1987 Feb, 155(2), 277 - 82 Association of meningococcal serotypes with the course of disease: serotypes 2a and 2b in the Netherlands, 1959-1981; Spanjaard L et al.; Case histories of 692 patients with meningococcal disease due to serogroup B, C, or W (W-135) were reviewed to study the association of the serotypes 2a and 2b with the course of disease . The case-fatality rate in group B disease was significantly associated with serotype 2b (B:2b) strains (P = 0.03) . Age and year of admission did not account for this association . Septicemia was also found more frequently with B:2b than with other B serotypes, but neurological complications and sequelae were not . Neither C:2a nor W:2a was associated with a higher case-fatality rate, with more cases of septicemia, or with more sequelae than were other C or W serotypes . We concluded that the 2b antigen, although not likely a causal factor, is a virulence marker among group B strains and that the protective effect of a vaccine containing this protein (among others) needs to be studied. Wien Klin Wochenschr, 1987 Jan 9, 99(1), 25 - 7 {Isolation of Neisseria meningitidis from the urethra and cervix}; Bohler-Sommeregger K et al.; Meningococcal infections of the urogenital tract were considered rare until recently, but over the past few years an increasing number of cases of this hitherto uncommon infection have been reported . The rising incidence of N . meningitidis isolated from these sites has important epidemiological implications . The need for careful diagnostic procedures is emphasized. J R Coll Physicians Lond, 1987 Jan, 21(1), 22 - 7 A global view of immunisation; Poore P; PIP: Focusing on the worldwide state of immunization, attention is directed to the progress being made in control of the 6 diseases -- measles, pertussis, diphtheria, tetanus, poliomyelitis, and tuberculosis -- using the vaccines and equipment now available . Major problems in world-wide vaccine coverage to be resolved are: management to ensure that adequate amounts of potent vaccine are delivered on time to susceptible infants; and funds to pay for this system of delivery over the next few decades . In 1974, at the time Expanded Program on Immunization (EPI) was conceived, 5% of infants in the developing world received a 3rd dose of DPT or polio vaccine . At this time, more than 1/3 of infants in the developing countries receive a 3rd dose of DPT or polio vaccine, although only about 20% receive measles vaccine . Progress has been made, but it is not sufficient if the global target is to be realized . Except for measles, the target diseases have been brought under control in most of the European region, and eradication targets have been set for the end of the century . Additionally, there is wide use of vaccines against other diseases of importance to public health including rubella, mumps, hepatitis B, influenza, pneumonococcal and meningococcal infections . Africa has the highest mortality and morbidity rates for the target diseases, yet there has been some progress in EPI . In 1983, 19 countries achieved fully immunized rates of 45-87% of their target population . A priority for the African region is the upgrading of the management skills of the health workers involved in EPI . A major constraint in the region is the need for a good 'cold chain" to ensure that vaccines are stored and transported within the safe temperature range . 26 countries in the American region are considered to have achieved control of paralytic poliomyelitis . Innovative ideas have been used in this region, including the use of national immunization days and revolving funds for bulk purchase of vaccines . In the Southeast Asia region there has been a slow but steady increase in coverage for all antigens except BCG and measles . The major constraints in the Western Pacific region as the other regions are lack of management skills and financial resources . Some progress has been made in the Eastern Mediterranean region despite great variation in socioeconomic status between countries . Alternative strategies for the acceleration of EPI activities are outlined . Scand J Infect Dis, 1987, 19(4), 403 - 7 Antimicrobial therapy and case fatality in meningococcal disease; Halstensen A et al.; The effect of different initial antimicrobial treatments on the case fatality rate (CFR) was evaluated in 112 consecutive patients with meningococcal disease . The overall CFR was 9.8% . 85 patients received initial therapy with chloramphenicol in addition to benzylpenicillin or other antimicrobials, and 27 patients benzylpenicillin or other antimicrobials without chloramphenicol . Patients treated with chloramphenicol had a lower CFR than those not given chloramphenicol (5% vs . 26%; p = 0.004) . However, severely ill patients were treated more often with penicillins, and adjustment for the severity of disease on admission to hospital demonstrated that this difference in favour of chloramphenicol was slight and nonsignificant (p = 0.58) . High doses of benzylpenicillin and no chloramphenicol were also associated with a higher CFR than low doses . However, the difference was not significant (p = 0.22) . More extensive studies should be carried out to evaluate the effect of benzylpenicillin doses and chloramphenicol on the outcome of meningococcal disease. Intensive Care Med, 1987, 13(5), 337 - 41 Significance of the changes in plasma amino-acid levels in meningococcal infection; Conejero R et al.; A series of patients with meningococcal infections have been studied and divided in two groups: Group I patients with meningococcal sepsis and group II, those with meningococcal meningitis . Patients in group I presented with more severe encephalopathy, shock, DIC and acute systemic complications . Both groups showed a marked hypoaminoacidemia compared with normal controls (other than for the sulfur containing amino acids and phenylalanine) . The concentration of aromatic and basic amino acids, the phenylalanine/tyrosine ratio, the transaminase levels and the negative nitrogen balance were higher in group I patients . The ratio of branched chain to aromatic amino acids was lower in group I . All these differences were statistically significant . The close association between the metabolic derangements and clinical manifestations may help in the understanding of several physiopathological aspects of meningococcal infections. Scand J Infect Dis, 1987, 19(1), 51 - 4 Primary meningococcal arthritis; Andersson S et al.; Arthritis in meningococcal disease is not uncommon and can be caused by either septic invasion of joints or allergic manifestations . Primary meningococcal arthritis (PMA) is, on the other hand, a rare form of meningococcal disease presenting as an isolated septic arthritis without other signs of meningococcal disease . We describe here the first two cases of PMA reported from Scandinavia . The patients were males, 3 and 47 years old, both with arthritis in an ankle joint . PMA is most commonly seen among male infants . Large joints, mainly knee joints, are most often involved and not seldom is the disease polyarthritic . PMA may appear with a previous or on-going upper respiratory tract infection and/or a maculopapular skin rash . If properly treated the prognosis is good. Scand J Infect Dis, 1987, 19(1), 35 - 42 Case fatality of meningococcal disease in western Norway; Halstensen A et al.; In the period 1976-84, 211 patients hospitalized with meningococcal disease were examined for possible relation between various epidemiological parameters and fatality . The peak incidences were in the age groups 0-4 and 13-18 years, with teenage girls peaking 2 years ahead of the boys . The overall case fatality rate was 8.5% . In septicemic patients (without meningitis) hypotension and/or ecchymoses on admission correlated strongly with a poor prognosis . Most deaths occurred during the months of March and November, and none during the summer months . There was a significant clustering of deaths among patients admitted during the morning hours, probably due to delayed diagnosis and treatment during the night . Since almost all patients who died had skin bleedings on admission, frequent examination of the skin in cases with acute unexplained fever might have saved lives. Aust N Z J Surg, 1987 Jan, 57(1), 57 - 60 Skin necrosis secondary to meningococcal septicaemia in an adult; Fielding GA et al.; A case of skin loss after meningococcal septicaemia is presented . This is a rare condition in adults and occurs after very severe infections . The skin loss is due to vasculitis, resulting from a combination of direct infection of the skin by Neisseria meningitidis, and an immunological reaction . Secondary infection frequently occurs under the eschar . Skin loss is treated by debridement and delayed split skin grafting. Clin Exp Immunol, 1987 Jan, 67(1), 55 - 8 Combined familial C7 and C4B deficiency in an adult with meningococcal disease; Chapel HM et al.; A case of meningococcal septicaemia is reported in an adult with a deficiency of the seventh component of complement combined with a deficiency of the B locus product of C4 . A family study demonstrated that the two deficiencies were not linked . This is the first time that the individual alleles of C4 were determined in a patient with a deficiency of one component of the terminal pathway . It is possible that the heterogeneous clinical picture of a terminal pathway deficiency may, in part, be explained by the co-existence of other subtle complement defects. Trans R Soc Trop Med Hyg, 1987, 81(4), 536 - 8 Mortality from meningococcal disease during an epidemic in The Gambia, West Africa; Greenwood BM et al.; Mortality from meningococcal disease was determined during an epidemic in a rural area of The Gambia with few medical resources, but where a system of registration of births and deaths had been established before the introduction of a primary health care programme . 33 deaths were recorded among 127 patients, a case mortality rate of 26% . 84% of deaths occurred within the first 24 h of illness and many patients died before they could reach any source of treatment . Previous studies, based on regional statistics or on hospital series, may have underestimated mortality from epidemic meningitis in Africa . Mortality from this infection will be reduced only if treatment can be made readily accessible to patients early in the course of their illness. Scand J Infect Dis, 1987, 19(6), 635 - 9 Meningococcal disease in congenital absence of the fifth component of complement; Nielsen HE et al.; We describe a family in which 2 brothers had meningococcal infection, 1 of them twice . Their parents were first degree cousins . The brothers showed a complete, isolated deficiency of C5, both antigenic and functional . The parents had half-normal values, and the data are compatible with an inherited C5 deficiency where the defect is transmitted as an autosomal codominant trait. Arkh Patol, 1987, 49(11), 87 - 9 {Diagnosis of pneumococcal meningitis}; Krukovskii BV et al.; Acute pneumococcal meningitis runs the course of meningoencephalitis morphologically, and when the incidence of meningococcal meningitis is on the increase, this disease may well be mistaken for pneumococcal meningitis (two case reports of such misdiagnosis are presented) or stroke (one case is reported) . An effective method for recognizing pneumococcal meningitis at an early stage is bacterioscopic examination of Gram-stained cerebrospinal-fluid smears. Antonie Van Leeuwenhoek, 1987, 53(6), 575 - 84 Cytopathic effects of the pathogenic Neisseria . Studies using human fallopian tube organ cultures and human nasopharyngeal organ cultures; Stephens DS et al.; Infection of mucosal surfaces by N . gonorrhoeae and N . meningitidis may result in inflammation indicating potential injury to host cells . We used human fallopian tube organ cultures (FTOC) and human nasopharyngeal organ cultures (NPOC) to study the mechanisms by which gonococci and meningococci damage human mucosal surfaces . Early in the course of FTOC infected with gonococci and NPOC infected with meningococci, damage was most apparent to ciliary activity . Loss of ciliary activity was accompanied by sloughing of ciliated cells . The damage to ciliated cells was not associated with attachment of gonococci or meningococci to these cells or the presence of organisms within ciliated cells . Infection with the commensal N . subflava did not result in significant damage to human FTOC or NPOC ciliary activity . LPS appears to be a major toxin of gonococci for human FTOC ciliated cells . Gonococcal peptidoglycan fragments also damage FTOC ciliary activity . Both piliated (P+) and nonpiliated (P-) gonococci and meningococci damage FTOC and NPOC ciliary activity, but P+ organisms damage ciliary activity more rapidly than P- organisms . Damage to FTOC ciliated cells was produced by less than 10 micrograms/ml of purified gonococcal and meningococcal LPS . By 1-2h after exposure to LPS, vesicles containing LPS were distributed throughout the cytoplasm of ciliated cells . Polymyxin B neutralized LPS-induced damage, suggesting that the lipid A portion of LPS was the toxic moiety . In contrast, purified gonococcal and meningococcal LPS at 100 micrograms/ml did not damage human NPOC or FTOC from rabbits, pigs and cows . These studies indicate that N . gonorrhoeae and possibly N . meningitidis damage ciliated epithelial cells indirectly by release of toxins from the organisms . The differences in susceptibility of FTOC and NPOC to LPS may suggest changes in density of receptors for LPS and may help explain variation in severity of gonococcal and meningococcal interactions at different human mucosal surfaces. Antonie Van Leeuwenhoek, 1987, 53(6), 557 - 64 Differential expression of "Fe-repressible" and "growth-rate-sensitive" proteins in Neisseria meningitidis and Neisseria gonorrhoeae; van Putten JP et al.; By varying growth conditions, we were able to differentiate (SDS-PAGE) between true "Fe-repressible" proteins and "growth-rate-sensitive" proteins (GSP's) (60-110 Kd) in outer membranes of iron-starved meningococci and gonococci . Immunological characterization with monoclonal antibodies raised against the GSP's revealed (GIRA) crossreactivity between different GSP's . On the basis of common epitopes, two groups of proteins could be distinguished . Immuno-electron-microscopy showed that proteins of both groups were exposed at the cell surface. Antonie Van Leeuwenhoek, 1987, 53(6), 519 - 22 Structure and immunochemistry of meningococcal lipopolysaccharides; Jennings HJ et al.; The structures of the largest dephosphorylated oligosaccharides (OS) obtained by mild acid hydrolyses of the L2, L3 and L5 serotype lipopolysaccharides (LPS) of Neisseria meningitidis have been elucidated . The OS have extensive regions of structural similarity of which some are responsible for cross-reactivity among the meningococcal LPS . However, the fact that the LPS are predominantly serotype-specific antigens implies that the terminal lacto-N-neotetraose unit, common to all the above OS, is not immunodominant, and that the major LPS serotype specificity originates in the inner core region of the OS. Antonie Van Leeuwenhoek, 1987, 53(6), 465 - 9 Characterization of the major iron-regulated protein of Neisseria gonorrhoeae and Neisseria meningitidis; Morse SA et al.; The major iron-regulated protein (MIRP) was purified, from both Neisseria gonorrhoeae and N . meningitidis by selective extraction with cetyltrimethylammonium bromide followed by ion-exchange and moleculair-seive chromatography . Solutions of the purified proteins had a characteristic pink color . The overall amino acid composition of these proteins was similar, although differences were noted in the number of serine, threonine, and lysine residues . Nevertheless, the N-terminal amino acid sequence was identical through 47 residues for both the meningococcal and gonococcal MIRP . Plasma emission spectrophotometry revealed that the meningococcal 37K protein contained ca . 1 mole Fe/mole protein. Antonie Van Leeuwenhoek, 1987, 53(6), 403 - 11 Human bactericidal antibody response to meningococcal outer membrane protein vaccines; Zollinger WD et al.; Several different meningococcal outer membrane protein vaccines have been prepared and used in human safety and immunogenicity studies . The results of these studies have led to some general conclusions regarding the human antibody response to these vaccines . A review of these conclusions, however, indicates that a number of important questions and problems still need to be addressed . Two of these are the determination of the protective level of bactericidal antibody in human serum and the impact of phase variation of surface antigens on vaccine strategy . Bactericidal assays using intrinsic complement and high concentrations of serum suggest that the level of natural immunity to group B meningococci is quite high, but is increased by vaccination with outer membrane protein vaccine . Phase variation in meningococcal surface antigens includi