Acta Pathol Microbiol Immunol Scand {C}, 1985 Jun, 93(3), 143 - 4 Purification of anti-lactose antibodies from antisera to Neisseria gonorrhoeae and Neisseria meningitidis; Brakstad OG et al.; Lactosyl-sepharose 4B columns were used for purification by affinity chromatography of anti-lactose antibodies from rabbit antisera to the gonococcal strains 8551 and VII, and the serogroup B meningococcal strain M982 . Anti-lactose antibodies were obtained from all three antisera . SDS-PAGE of lipopolysaccharide and of bacterial cells and immunoblotting with the anti-lactose antibodies showed that the lipopolysaccharide was the only bacterial component with binding sites for the antibodies. J Hyg (Lond), 1985 Jun, 94(3), 279 - 88 Carriage of Neisseria meningitidis and Neisseria lactamica in a school population during an epidemic period in Spain; Saez-Nieto JA et al.; A study was made of the incidence of Neisseria meningitidis and N . lactamica in a school population; 2470 children aged between 5 and 7 years were studied from four schools in Alcala de Henares (Madrid) . Nasopharyngeal swabs were taken in June, November and March, between 1979 and 1983 . In all the surveys except one, the proportion of carriers of N . lactamica was higher than that of N . meningitidis, reaching a ratio of about 2:1 in the complete study . The predominant serogroup of meningococcus found was B (41%), with nongroupable strains reaching 43% . A study of serotypes within group B showed a predominance of nontypable strains (48.5%), while those strains considered to be most virulent (types 2 and 1, 8, 15) reached 40% . Eighteen per cent of N . lactamica strains were observed to agglutinate with antimeningococcal sera whilst the remainder of the strains were rough . When these strains were studied with the antiserum-agar technique, using antimeningococcal sera, a high percentage of strains cross-reacted with the meningococci . The susceptibility of strains to sulphadiazine, penicillin, ampicillin, chloramphenicol, rifampicin and spiramycin was determined . Finally an analysis was made of the effect that an elevated colonization rate of N . lactamica might have on colonization by meningococci . The necessity of using fine epidemiological markers in tracing virulent strains in a population at risk is stressed . Selective prophylactic measures are also necessary. J Exp Med, 1985 Jun 1, 161(6), 1539 - 53 Pili of Neisseria meningitidis . Analysis of structure and investigation of structural and antigenic relationships to gonococcal pili; Stephens DS et al.; To provide information useful for the design of a pilus vaccine effective for the prevention of both meningococcal and gonococcal disease, the electron microscopic morphology of meningococcal pili and the structural and antigenic relationships of meningococcal pili to gonococcal pili were investigated . Meningococcal pili were 4-6 nm in width, extended 500-6,000 nm from the organism surface, and occurred singly or in bundles composed of 8-10 pili per bundle . Meningococcal pilin varied between 17,250 and 20,600 daltons . Pilin was present in outer membrane preparations of some meningococcal isolates that were nonpiliated by electron microscopic examination . Antibodies to gonococcal pili, cyanogen bromide cleavage fragments of gonococcal pilin, or synthetic peptide analogues corresponding to regions of the gonococcal pilin sequence, were used to detect common meningococcal and gonococcal antigenic determinants that might indicate the existence of a conserved sequence beyond residue 29 . Antibody to intact gonococcal pili or to the variable CNBR-3 region of gonococcal pilin detected little shared antigenicity with meningococcal pilin . However, pilin from all tested meningococcal isolates reacted with antibody to the CNBR-2 fragment of gonococcal pilin, a region highly conserved among gonococcal strains . Meningococcal pilins were also broadly crossreactive with antibody to a synthetic peptide corresponding to residues 69-84 of the gonococcal sequence, a part of the CNBR-2 region that appears to be critical for gonococcal receptor-binding function . If a sequence similar to 69-84 is also important for receptor-binding function in meningococcal pili, a peptide corresponding to this region may elicit antibodies that block the adherence function of pili elaborated by both Neisseria gonorrhoeae and N . meningitidis. Med Clin North Am, 1985 May, 69(3), 487 - 504 The hereditary and acquired deficiencies of complement; Nusinow SR et al.; The identification of hereditary and acquired complement deficiencies in humans has led to a better understanding of the biologic importance of the complement system in immunity and autoimmune disease . Although the understanding of the relevance of complement in the pathogenesis of disease is incomplete, several characteristic clinical syndromes associated with complement deficiencies have been recognized and should be known to the practicing clinician . In allergic diseases, one need recognize the C1 inhibitor deficiency syndromes which can present as severe, recurrent angioedema in childhood or in the adult as recurrent angioedema in association with a lymphoid malignancy or autoimmune disease . Complement analyses allow one to readily diagnose C1 inhibitor deficiency in angioedema . Correct diagnosis is critical because safe effective therapy is available . Chronic urticaria is also uncommonly associated with complement deficiencies, particularly acquired C1q deficiency . Again, effective therapy for hypocomplementemic urticarial vasculitis and C1q deficiency is available and differs significantly from the usual management of chronic urticaria . Homozygous and acquired deficiencies of C3 are associated with severe immune deficiency and recurrent infections with gram-positive and gram-negative bacteria . Recurrent meningococcemia and gonococcemia are being identified frequently in patients with a deficient membrane attack mechanism relating to deficiency of C5, C6, C7, or C8 . Nearly one third of the patients developing meningococcemia may have an associated complement deficiency indicating the importance of complement determinations in understanding the treatment and prognosis for these patients . Deficiency of almost every complement component has been reported in association with one or more rheumatic diseases, particularly systemic lupus erythematosus . Extensive studies of C2 deficiency and limited studies of C4 deficiency indicate that these components of the classical pathway of complement are important in preventing the development of SLE or are linked to other genes predisposing to SLE . The clinical presentations of SLE in association with C2 or C4 deficiency are relatively uniform . The patients exhibit typical skin manifestations suggestive of SLE and DLE and often exhibit antibodies to SSA (Ro) . The association of complement deficiencies with clinical syndromes is important for today's physician . The syndromes and deficiencies described here are the beginning of an expanding knowledge relating to the pathobiology of complement in human disorders. J Clin Microbiol, 1985 May, 21(5), 734 - 7 Evaluation of the RIM-N, Gonochek II, and Phadebact systems for the identification of pathogenic Neisseria spp . and Branhamella catarrhalis; Janda WM et al.; Methods for identifying Neisseria spp . include conventional and modified carbohydrate degradation procedures, chromogenic enzyme substrate tests, and immunologic coagglutination tests for Neisseria gonorrhoeae . In this study, we evaluated the abilities of the RIM-N carbohydrate degradation system (American MicroScan, Campbell, Calif.), the Gonochek II enzymatic identification system (Du Pont Co., Wilmington, Del.), and the Phadebact Gonococcus coagglutination test (Pharmacia Diagnostics, Piscataway, N.J.) to identify pathogenic Neisseria spp . and Branhamella catarrhalis . Both stock strains and clinical isolates, including 176 N . gonorrhoeae, 173 Neisseria meningitidis, 48 Neisseria lactamica, and 12 B . catarrhalis strains, were tested . The RIM-N identified 98% of the gonococci, 99% of the meningococci, 94% of the N . lactamica strains, and 100% of the B . catarrhalis strains within 1 h . The Gonochek II system identified 99% of the gonococci, 97% of the meningococci, 100% of the N . lactamica strains, and 100% of the B . catarrhalis strains within 30 min . Phadebact coagglutination provided clearly positive results for only 77% of the N . gonorrhoeae strains, producing negative or equivocal results with 23% of the strains . The RIM-N and Gonocheck II tests generally produced clear-cut reactions . An additional advantage of the Gonocheck II system was the small inoculum required for the performance of the test compared with the other systems, thus allowing the identification of N . gonorrhoeae directly from the primary isolation medium. Infect Immun, 1985 May, 48(2), 428 - 32 Immunoresponses to Neisseria meningitidis epitopes: primary versus secondary antiphosphorylcholine responses; Faro J et al.; Specific antiphosphorylcholine immune responses were found to be elicited by different Neisseria meningitidis group B M986 preparations . Our results suggest the functional presence of phosphorylcholine in the bacteria . The immune responses, mostly immunoglobulin M, were measured with a plaque-forming cell assay . The secondary phosphorylcholine-specific immune response induced by intact meningococci was significantly lower than the primary phosphorylcholine-specific immune response induced by the same antigens . This suppression is priming time dependent and does not represent an early switching to the expression of other classes of immunoglobulins. Infect Immun, 1985 May, 48(2), 336 - 42 Structural and antigenic analysis of meningococcal piliation; Olafson RW et al.; Pilin with an Mr of 16,500 was purified to homogeneity from Neisseria meningitidis SP3428 . Procedures which provided useful separation during purification included high-pressure liquid chromatography with a TSK size exclusion column, Sephacryl S-200 column chromatography, ion-exchange chromatography with SP-Sephadex, and preparative sodium dodecyl sulfate-polyacrylamide gel electrophoresis . The amino acid composition of this pilin was similar to that previously reported for this species . The sequence of N-terminal 51 amino acids was also determined . The protein lacked a modified phenylalanine at the amino terminus and displayed six residues which were different from Neisseria gonorrhoeae in that region of the molecule determined to be the lectin-binding domain . Monoclonal antibody raised to this pilin was employed, along with a monoclonal antibody to an epitope common to all gonococcal pilins, to analyze the intra- and interstrain heterogeneity of meningococcal piliation . The results indicate that N . meningitidis displays considerable intra- and interstrain heterogeneity with respect to both pilus subunit size and antigenicity . The Mr of subunits ranged from 13,000 to 20,000. Zh Mikrobiol Epidemiol Immunobiol, 1985 Apr, (4), 66 - 9 {Modification of an immunoradiometric analysis method and the coagglutination reaction in the diagnosis of meningitis}; Alekseeva NV et al.; The coagglutination test and the radio-immunoassay (RIA) in the authors' modification have been used for the rapid diagnosis of meningococcal meningitis . This modification of RIA has been found to be highly sensitive with respect to soluble microbial antigens . In the study of liquors from patients with acute meningitides of different etiology RIA has been shown to have a higher efficiency in comparison with the coagglutination test . The data thus obtained indicate good prospects for the use of RIA in experimental and diagnostic investigations. Clin Exp Immunol, 1985 Apr, 60(1), 183 - 90 Inherited C8 beta subunit deficiency in a patient with recurrent meningococcal infections: in vivo functional kinetic analysis of C8; Rao CP et al.; A 16 year old with recurrent meningococcal infections is reported . Absence of haemolytic activity in both the classical and alternative pathways resulted from an absence of functional C8 . Addition of functional C8 restored hemolytic activity . Antigenically deficient C8 was present in the serum and isoelectric focusing of serum confirmed the absence of the C8 beta chain . Following the infusion of fresh frozen plasma, we followed the decay in C8 functional activity as well as total haemolytic activity . C8 activity peaked at about 3 h with a half-life survival estimated to be 28 h . The kinetics of total haemolytic activity showed a slower decay with an exponential decline over 72 h and a half-life of 55 h . Fresh frozen plasma may be of value in the treatment of patients with C8 deficiency and acute Neisserial infections. J Med Microbiol, 1985 Apr, 19(2), 203 - 9 Colony variants of Neisseria meningitidis strain 2996 (B:2b:P1.2): influence of class-5 outer membrane proteins and lipopolysaccharides; Poolman JT et al.; Different colonial morphologies were found among colonies of Neisseria meningitidis strain 2996 (B:2b:P1.2) . Examination of cultures, selected on the basis of colony transparency or opacity, revealed that both lipopolysaccharides (LPS) and class-5 outer membrane proteins (OMP) are associated with differences in colonial morphology . Among 13 variants, four LPS variants and two class-5 OMP variants were recognised . All variants were non-fimbriate . The LPS variations were confirmed by immunoprecipitation . In addition to these qualitative variations of LPS, meningococci synthesise LPS of different molecular size depending upon growth phase; larger LPS molecules were found after analysis of stationary-phase cultures than with exponential-phase cultures . These changes did not cause a change in serotyping characteristics . The recognition in this study of intra-strain heterogeneity of meningococcal LPS and class-5 OMPs is important for the understanding of meningococcal pathogenicity . This heterogeneity was also detected in simultaneous isolates from different sites of a patient. Infect Immun, 1985 Apr, 48(1), 23 - 8 Recognition of serogroup A Neisseria meningitidis serotype antigens by human antisera; Sugasawara RJ; The antigens of Neisseria meningitidis serogroup A which were recognized by human antisera were identified by Western blot and enzyme-linked immunosorbent assay techniques . The components of six prototype strains used for serotyping serogroup A meningococci were resolved by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and then transferred to nitrocellulose for immunoperoxidase staining with sera collected from 10 acute-phase and 14 convalescent-phase patients . Six acute-phase sera detected six major antigens having apparent molecular weights between 14,000 and 82,000 . In addition to recognizing these antigens, the convalescent-phase sera detected a protease-sensitive antigen with an apparent molecular weight of 20,000 for one strain and 27,000 for five strains, lipopolysaccharide, and the heat-modifiable proteins . The sera recognized lipopolysaccharide in a serotype-specific manner, whereas their reactions with the heat-modifiable protein were not serotype specific . Convalescent-phase sera recognized components from eight meningococcal serogroups . The concentrations of immunoglobulin G directed to capsular polysaccharide were determined by the enzyme-linked immunosorbent assay; seven acute-phase sera had less than 0.39 micrograms of antibody per ml, whereas the average concentration in convalescent-phase sera was 3.22 micrograms/ml and the range was 0.40 to 7.50 micrograms/ml. J Infect Dis, 1985 Apr, 151(4), 650 - 7 Neisserial antigen H.8 is immunogenic in patients with disseminated gonococcal and meningococcal infections; Black JR et al.; Antigenic diversity among and within strains of Neisseria gonorrhoeae and Neisseria meningitidis has complicated studies of the pathogenesis of these strains and obstructed vaccine development . We previously described a distinct surface antigen (H.8) common to pathogenic Neisseria . We have now demonstrated in vivo expression of the H.8 antigen by detecting antibody responses to the antigen in 13 patients with disseminated neisserial infections . Each serum sample from a convalescent patient blocked the binding between the infecting meningococcal or gonococcal strain and a monoclonal antibody directed to the H.8 antigen, as demonstrated by binding-inhibition studies in enzyme-linked immunosorbent assays (P less than .005) . Testing by sodium dodecyl sulfate-polyacrylamide gel electrophoresis and western blotting demonstrated an IgG response in each convalescent serum to an antigen co-migrating with the H.8 antigen . Specificity of this antibody response was confirmed by probing recombinant bacteriophage that expressed the H.8 antigen . The commonality and the immunogenicity of the H.8 antigen indicate its possible role in the pathogenesis of, and its potential as a vaccine component for, gonococcal and meningococcal diseases. Helv Paediatr Acta, 1985 Apr, 40(1), 9 - 16 {Current therapy of meningococcal infection in childhood}; Sutter MU; The article discusses the present therapy of acute meningococcal septicemia . Besides adequate antibiotic treatment, the importance of early and aggressive shock and respiratory therapy, i.e . endotracheal intubation and mechanical ventilation, is stressed . The role of corticosteroids is discussed . The use of anticoagulants, fibrinolytic agents and inhibitors of fibrinolysis is discouraged. Sex Transm Dis, 1985 Apr-Jun, 12(2), 88 - 9 Postmeningococcal urethritis caused by Chlamydia trachomatis: a case report; Lefevre JC et al.; The authors describe a case of meningococcal urethritis that was followed, after treatment with spectinomycin, by development of urethritis due to Chlamydia trachomatis . This case report emphasizes the need for thorough differentiation of species of Neisseria and of direct microbiologic diagnosis of chlamydial infection in laboratories. J Immunol, 1985 Apr, 134(4), 2651 - 7 Determinant specificities of the groups B and C polysaccharides of Neisseria meningitidis; Jennings HJ et al.; A meningococcal group B-specific horse antiserum contains at least two distinct populations of antibodies with specificities for determinants on the group B capsular polysaccharide antigen . These two populations were differentiated on the basis of the ability of only one of them to be absorbed from the antiserum by the structurally related colominic acid . The nature of the colominic acid-specific determinant was elucidated by a radioimmunoassay inhibition technique with the use of a series of linear alpha-(2----8)-linked oligomers of sialic acid as inhibitors . Colominic acid was labeled by prior removal of its N-acetyl groups, followed by their replacement with the use of {3H}acetic anhydride . The conformational nature of the determinant was proposed because of the unusually large size (10 sialic acid residues) of the oligomer required to function as an efficient inhibitor . The structure of the determinant responsible for the second population of group B-specific antibodies has not been determined, but it is obviously based on an as yet undefined conformational or structural feature peculiar to the group B meningococcal polysaccharide . In contrast to the colominic acid-specific group B determinant, the determinant responsible for the group C polysaccharide-specific rabbit antibodies proved to be more conventional . Inhibitory properties of the alpha-(2----9)-linked oligomers maximized with those containing four or five sialic acid residues, which is consistent with the approximate estimated maximal size of an antibody site. Zh Mikrobiol Epidemiol Immunobiol, 1985 Apr, (4), 63 - 6 {Increased specificity of immunoenzyme analysis for diagnosing meningococcal infection}; Zhuravleva GV et al.; The ELISA test system for the detection of polysaccharide antigens of meningococci, groups A and C, on the basis of the neutralization of specific antibodies has been developed . The specificity of this reaction is determined by the chemically pure preparations of group A and C meningococcal polysaccharides . The sensitivity of this test system based on the neutralization of antibodies is not inferior to that of ELISA with the use of double antiserum. MMWR Morb Mortal Wkly Rep, 1985 Mar 8, 34(9), 119 - 20, 125 Epidemic meningococcal disease: recommendations for travelers to Nepal; Immune complexes and the pathogenesis of meningococcal arthritis; Immune complex levels were measured in serum and synovial fluid obtained from 10 patients who developed arthritis 3-8 days after the onset of meningococcal meningitis . Mean serum immune complex levels were lower in these patients than in eight age matched control patients with meningococcal disease who did not develop late complications . This observation suggests that meningococcal arthritis follows local formation of immune complexes in the synovium rather than deposition of circulating immune complexes . Purified meningococcal polysaccharide antigen-induced synovitis when injected into the knee of rabbits previously sensitized by i.v . injection with heat killed meningococci. J Clin Microbiol, 1985 Mar, 21(3), 464 - 6 Neisseria meningitidis serogroup 29E (Z') septicemia in a patient with far advanced multiple myeloma (plasma cell leukemia); Wachter E et al.; A case of septicemia caused by Neisseria meningitidis serogroup 29E (Z') in a patient with plasma cell leukemia is described . The patient developed disseminated intravascular coagulation, had a cardiopulmonary arrest, and died . The effects of altered immune function leading to a predisposition to meningococcal infections are discussed. Schweiz Med Wochenschr, 1985 Feb 23, 115(8), 281 - 4 {Acute myocardial dysfunction in meningococcal septicemia}; Horisberger JD et al.; A progressive myocardial dysfunction is known to occur in prolonged septic shock . The cases of two patients with acute meningococcal infection and Waterhouse-Friderichsen syndrome are reported . Hemodynamic measurements showed, in the early stage, the classical picture of hyperdynamic septic shock, with increased cardiac output and low systemic vascular resistances . However, rapidly progressive cardiac failure then occurred, with high filling pressures and low cardiac output . One patient went into irreversible shock . In the other the administration of inotropic agents was beneficial, with a slow but progressive improvement in left ventricular function over several weeks . Acute myocarditis has been frequently observed in patients with meningococcal infections . It is suggested that the acute myocardial failure observed in those circumstances is caused by the myocarditis. Proc Natl Acad Sci U S A, 1985 Feb, 82(4), 1194 - 8 NZB mouse system for production of monoclonal antibodies to weak bacterial antigens: isolation of an IgG antibody to the polysaccharide capsules of Escherichia coli K1 and group B meningococci; Frosch M et al.; A system for the production of monoclonal antibodies, particularly of the IgG type, against weakly immunogenic bacterial polysaccharide antigens is described . This system, which is based on the autoimmune NZB mouse strain, has been used to produce a monoclonal IgG2a antibody against the meningococcus group B and Escherichia coli K1 polysaccharides, identical homopolymers of alpha (2----8)-linked units of N-acetylneuraminic acid that are extremely poor immunogens . Comparison of the humoral immune responses of normal BALB/c mice and autoimmune NZB mice to hyperimmunization with group A, B, and C meningococci showed that, although both strains mounted a weak meningococcal B polysaccharide-specific IgM response, only the NZB strain mounted an IgG response . Similarly, NZB mice mounted a stronger IgG response to the more immunogenic group C meningococcal polysaccharide than did BALB/c mice, although this difference was less pronounced than that observed with meningococcal B polysaccharide . No difference between the two strains of mice was demonstrable with the strongly antigenic group A meningococcal polysaccharide . These results indicate that the NZB system may be generally useful for the production of monoclonal antibodies against weakly antigenic bacterial determinants. Infect Immun, 1985 Feb, 47(2), 465 - 71 Influence of nutrient limitation and low pH on serogroup B Neisseria meningitidis capsular polysaccharide levels: correlation with virulence for mice; Masson L et al.; Neisseria meningitidis strain M986, which possesses a polyanionic sialic acid capsular polysaccharide, was resistant to the bactericidal effects of normal rabbit serum, but sensitive when immune serum and complement were present . An isogenic strain PRM102, deficient in the ability to produce capsular polysaccharide, was sensitive to normal serum . Strain M986, when grown under conditions of low pH or nutrient limitation, synthesized increased levels of capsular polysaccharide . This was accompanied by an increase in cell surface hydrophilicity and virulence for mice . Cells grown in low-pH, iron-limited medium synthesized the highest concentration of polysaccharide and exhibited the highest cell surface hydrophilicity and virulence among the cases examined . The increase in capsular polysaccharide was partly explained by a decrease in the specific activity of a membrane-bound cytidine monophosphate-N acetylneuraminic acid hydrolase . The results suggest that conditions of nutrient limitation and low pH exert profound effects on the physicochemical nature of the meningococcal cell surface which, in turn, cumulate in enhanced virulence of this organism for mice. J Biol Chem, 1985 Jan 25, 260(2), 1265 - 70 Cleavage of the polysialosyl units of brain glycoproteins by a bacteriophage endosialidase . Involvement of a long oligosaccharide segment in molecular interactions of polysialic acid; Finne J et al.; Polysialosyl chains containing alpha 2-8-linked N-acetylneuraminic acid have been suggested to modulate the biological activity of a neural cell adhesion molecule . Polysialosyl glycopeptides isolated from developing brain were incubated with a bacteriophage containing endosialidase . Sialic acid oligomers up to 7 residues long were liberated both from the glycopeptides and colominic acid . The substrate specificity of the endosialidase was studied with sialic acid oligomers of different sizes prepared from colominic acid . It was found that the endosialidase required the simultaneous presence adjacent to the site of cleavage a minimum of 3 sialic acid residues on the distal side and a minimum of 5 sialic acid residues on the proximal (reducing end) side . From the fragments liberated by the enzyme the existence of polysialic acid chains up to at least 12 residues long in the glycopeptides were concluded . This was also supported by the interaction of the glycopeptides with a meningococcal group B polysaccharide antiserum, which was found to require 10 residues or more for binding . The results indicate that the brain polysialosyl glycopeptides contain a long polysialic acid segment, which is also specifically needed for certain molecular interactions . The implications of the findings for the biological properties of the neural cell adhesion molecule are discussed. S Afr Med J, 1985 Jan 5, 67(1), 7 - 9 Meningococcal arthritis; Bhettay E et al.; Meningococcal infection (MI) remains endemic in the Western Cape . A review of 2216 cases in which the condition was diagnosed and notified to the relevant authorities between January 1977 and March 1982 is presented . In 121 patients the disease was complicated by meningococcal arthritis (MA) . MI and MA occurred most commonly in the Coloured population; over 50% of patients with MI were less than 2 years of age; and patients with MA were slightly older than the sample mean . The onset of arthritis showed a biphasic pattern with an early peak at 1-2 days and a later peak, heralded by typical recrudescence of fever, at 5-10 days which usually lasted 5-7 days . It was most often monarticular, the knee being the joint most frequently affected . Four cases of isolated MA were also encountered. Arkh Patol, 1985, 47(10), 7 - 16 {Current problems in the pathological anatomy of acute neuroinfections in children}; Tsinzerling VA; The analysis of the autopsy material of children dying from acute neuroinfections in a specialized department of the Research Institute of Children's Infections from 1954 to 1984 is presented . The increase of the importance of hypertoxic forms of meningococcal infection, purulent meningoencephalitis (particularly those of pneumococcal etiology) as well as acute viral encephalitis (particularly herpetic ones) is noted at present . The results of the materials studied by the author from 182 children dying of those infections at the period from 1971 to 1984, the problems of their patho- and tanatogenesis are discussed . Special attention is drawn to the necessity of considering the type of an etiological agent, its properties, the features of tissue response and those of the immunological resistance in the brain for the diagnosis and epicritic assessment of acute neuroinfections. J Infect, 1985 Jan, 10(1), 51 - 6 Meningococcal endocarditis with profound acquired hypocomplementaemia; Weetman AP et al.; A patient is described who presented with chronic endocarditis, due to Neisseria meningitidis, affecting a previously normal mitral valve . The illness was associated with glomerulonephritis that caused renal impairment and the nephrotic syndrome . Despite antibiotic treatment and replacement of the mitral valve, serum complement values remained very low, only returning to normal when immune complexes and a type III cryoglobulin disappeared from the circulation three months after resection of the valve vegetation . Such acquired hypocomplementaemia may have contributed to the chronicity of the disease process in this patient. Biomed Pharmacother, 1985, 39(4), 167 - 70 Factors influencing host susceptibility to meningococcal disease; Winstanley FP et al.; Host-parasite interactions influencing the development of the protective humoral immune response to Neisseria meningitidis are briefly reviewed . Possible consequences of the observed decreased titres of bactericidal activity specific for meningococcal serogroups A, B and C among patients with gonorrhoea are discussed with reference to: the epidemiology of the two diseases, the protective role of "natural" antibodies to the Neisseria species and the carriage rate of serogroupable strains of N . meningitidis among patients with gonorrhoea and a control population. Infect Control, 1985 Jan, 6(1), 37 - 40 Neisseria meningitidis; Stephens DS; N . meningitidis continues to be a worldwide cause of human disease, usually in otherwise healthy individuals . The natural habitat and reservoir for meningococci are the mucosal surfaces of the human nasopharynx and to a lesser extent, the urogenital tract and anal canal . In most instances meningococcal colonization of mucosal surfaces is asymptomatic but may produce local infection . In those individuals who lack serum bactericidal activity against the meningococcus, colonization of mucosal surfaces and bloodstream invasion by N . meningitidis can lead to devastating meningitis and septicemia . Recent studies on the ultrastructure of the meningococcus and on the mechanisms of pathogenesis have given us new insight into meningococcal infections and suggest ways for improved immunoprophylaxis . Currently, penicillin is the drug of choice for the treatment of meningococcal meningitis and septicemia . However, the report of meningococci with antibiotic resistant plasmids is alarming and in the future may alter traditional treatment regimens. Scand J Clin Lab Invest Suppl, 1985, 178, 53 - 5 Plasmapheresis in the treatment of severe meningococcal or pneumococcal septicaemia with DIC and fibrinolysis . Preliminary data on eight patients; Brandtzaeg P et al.; Plasmapheresis (50 ml fresh frozen plasma/kg body weight per session--total 9-11 liters) was performed within 36 hours of the onset of septicaemia in 7 patients (1 woman and 6 men, age 14-48 years) . One 8 year old girl was treated with exchange blood transfusion (2 liters) . All had symptoms of severe septic shock caused by Neisseria meningitidis (6) or by Streptococcus pneumoniae (2) . All patients demonstrated signs of DIC and concomitant fibrinolysis with low platelet values, normal to low fibrinogen levels, circulating soluble fibrin and increasing amounts of FDP . Persistent extreme values were observed in 2 patients that died, whereas coagulation/fibrinolysis parameters frequently improved during plasmapheresis and gradually (more than 6 days) returned to normal values in the survivors . Although plasmapheresis was largely successful and signs of DIC and fibrinolysis were normalized, 2 patients died and 1 survived with severe sequelae . Thus, it remains to accumulate more data to conclude if plasmapheresis is beneficial in the treatment of severe septic shock and DIC. Arkh Patol, 1985, 47(8), 26 - 32 {Pathogenetic and pathomorphological problems of viral-bacterial associations in children dying of meningococcal infection}; Tsinzerling VA et al.; The information on 63 children dying from hypertoxic forms of meningococcal infection is presented . Four groups of brain damage by respiratory viruses (RV) are distinguished on the basis of the results of morphological and virological examination: 1) with a recent RV generalization (26 cases); 2) with dissemination of an etiological agent but without clear-cut structural changes (6 cases); 3) with an isolated affection of the brain (13 cases); 4) without clear-cut brain damage . Experimental influenza-meningococcal infection was reproduced in 260 white rats . Enhancement of the animal death rate, multiplication of virus and the degree of brain damage in cases of combined action of both etiological agents is demonstrated . The ability of influenza virus, when inoculated intranasally together with meningococcus, to penetrate and to multiply in the brain provoking meningitis and choroiditis is shown virologically, histologically and electron microscopically. Eur Neurol, 1985, 24(5), 310 - 3 Peripheral neuropathy in meningococcal septicemia; Roig M et al.; We report a case of a mixed sensorimotor, predominantly axonal mononeuritis multiplex that developed after a severe meningococcal septicemia and disseminated intravascular coagulation (DIC) with associated distal limb necrosis . Ischemia resulting from the DIC-induced multiple vascular occlusions is suggested as the leading cause of this neuropathy. Scand J Infect Dis, 1985, 17(1), 19 - 24 Restriction fingerprinting and serology in a small outbreak of B15 meningococcal disease among Norwegian soldiers; Kristiansen BE et al.; In September 1981 a soldier died from meningococcal septicemia in a military camp in Mid-Norway . Soon afterwards one of his room-mates was transferred to a military camp in Northern-Norway where he shared sleeping quarters (room 7D) with 5 other soldiers of whom 2 fell ill with meningococcal disease 1 month later . Throat cultures were obtained from all 128 soldiers at the military camp in Northern-Norway; 41 (32%) harboured meningococci in their throats . The 3 invasive isolates and the isolates from the 4 healthy carriers at room 7D were all group B and type 15 meningococci . However, by DNA fingerprinting we could identify at least 2, probably 3, different individual strains among these 7 isolates . None of these strains were isolated from soldiers outside room 7D . By use of a B15 whole-bacterium ELISA method we showed that the levels of antimeningococcal IgG antibodies in the sera of the two cases at room 7D were low (18 and 28 OD units) compared with the mean IgG levels in the sera of their 4 healthy room mates (1150 OD units) and the mean IgG in the sera from all healthy soldiers (472 OD units). Int J Tissue React, 1985, 7(4), 321 - 8 The clinical significance of alpha 1-antitrypsin-elastase (alpha 1AT-ELP) and alpha 2-antiplasmin-plasmin (alpha 2AP-PL) complexes for the differentiation of coagulation protein turnover: indications for plasma protein substitution in patients with septicaemia; Seitz R et al.; In inflammation, particularly in septicaemia, complex coagulation disorders may lead to a dangerous haemorrhagic diathesis . The conventional concept for this syndrome called DIC implicates the occurrence of active thrombin in the circulation, which may be followed by hyperfibrinolysis due to plasmin formation . In this study data are presented suggesting an important role for a third proteolytic system, granulocytic elastase . The complexes of plasmin and elastase with their specific inhibitors, alpha 2-antiplasmin-plasmin (alpha 2AP-PI) and alpha 1-antitrypsin-elastase (alpha 1AT-ELP) were determined immunologically . The alpha 1AT-ELP appears mainly in gram-negative septicaemia, particularly in meningococcal disease . The estimation of alpha 2AP-PI and alpha 1AT-ELP, together with a method for the detection of the antithrombin III--thrombin complex which remains to be established, is a suitable tool for for the differential diagnosis of the consumption of coagulation proteins . The assumption that at least three proteolytic systems participate in the development of the haemorrhagic diathesis during inflammation leads to the concept of a broad, comprehensive substitution therapy with e.g . concentrates of AT III, PPSB, or fresh frozen plasma . The aim of this treatment is to replace not only the consumed procoagulatory factors, but also the lacking inhibitors in order to control this "abnormal proteolysis syndrome". Dev Biol Stand, 1985, 61, 525 - 30 A semi-synthetic glycoconjugate antigen prepared by chemical glycosilation of pertussis toxin by a meningococcal group C oligosaccharide hapten; Porro M et al.; The preparation of a hybrid molecule obtained by chemical glycosilation of pertussis toxin (PT) is reported, with the purpose of obtaining a semi-synthetic glycoprotein antigen with bivalent antigenicity . The chemical glycosilation was performed using an oligosaccharide hapten derived from the purified capsular polysaccharide of Neisseria meningitidis group C . The semi-synthetic molecule was investigated by chemico-physical and immunochemical analysis . The oligosaccharide haptens appeared exposed on the surface of the carrier protein PT, since the glycoprotein inhibited the immunoprecipitate between a specific polyclonal antiserum and the native bacterial capsular polysaccharide . By contrast, the main antigenic regions recognized in the native protein PT by specific polyclonal antibodies appeared lost after the coupling procedure involving PT as the carrier protein. N Z Med J, 1984 Dec 12, 97(769), 860 - 2 An outbreak of meningococcal disease: implications for community medicine; Buchan H et al.; A local outbreak of five hospitalised cases of meningococcal disease, one of which was fatal, occurred over a period of three weeks in a small community in one health district . The events surrounding this outbreak illustrate many of the problems of dealing with the community medicine aspects of potentially serious infectious disease . Difficulties in the management of the outbreak are identified and contributing factors discussed. NIPH Ann, 1984 Dec, 7(2), 69 - 82 Late sequelae after meningococcal disease as related to anamnestic and clinical factors recorded during the acute illness; Sander J et al.; In 71 males who survived acute meningococcal disease 3 to 15 years ago at an age of about 20, associations between acute clinical conditions (including a few pre- and post-admission variables) and late sequelae have been studied . There was a higher rate of sequelae symptoms (mainly light neurological and mental disturbances) among survivors from meningitis (76%) than among those who had had both meningitis and septicemia (58%) or pure septicemia (50%) . Twenty percent of control persons experienced such symptoms . "Changed Life" because of serious educational and working problems followed in 29% of the meningitis cases and 70% of the septicemia cases . Most of the clinical and laboratory factors separately examined were not significantly correlated to the sequelae rates . However, less than 2.5 mmol/l glucose in the cerebrospinal fluid (CSF) on admission (p less than 0.01), more than 1000 X 10(6) white blood cells per 1 in the cerebrospinal fluid (p less than 0.05), fever for more than 8 days (p less than 0.05), and probable cerebral symptoms the first week (p less than 0.05), were all positively correlated to a high rate of late sequelae . Well documented early sequelae correlated with serious late sequelae (p = 0.05) . No conspicuous associations between acute antibiotic treatment and late sequelae were found . A combination of CSF glucose, blood thrombocytes, and cells in CSF on admission yielded a multiple regression score which seems to be a moderately reliable predictor of sequelae (R = 0.46) . Hospital treatment should both aim at avoiding death and escaping residual effects . Because many prognostic factors for sequelae on admission are different from those for lethality, scoring for sequelae may be helpful in such secondary prevention of sequelae . Early standardized registration of sequelae may also be of value in tertiary prevention. Zh Mikrobiol Epidemiol Immunobiol, 1984 Dec, (12), 83 - 8 {Immunohormonal homeostasis in meningococcal meningitis}; Sokolov IaA et al.; The examination of 18 patients with meningococcal infection has revealed the presence of reciprocal relationships between changes in the content of cortisol and triiodothyronine in their blood, especially at the beginning of the disease . The dynamics of changes in the concentration of rosette-forming cells has proved to be similar to that of changes in the concentration of triiodothyronine . A decrease in the level of thyroid hormones in the blood has been observed in experimental infections and oncological processes in mice, rats or guinea pigs, as well as after the injection of adjuvants into these animals . The centroid factor analysis with the use of the criteria of symmetry and asymmetry has revealed 3 main factors in the process under study, interpreted as follows: the homeostasis destabilization factor of infectious nature (F1), the homeostasis maintenance and restoration factor of endogenous nature (F2) and the factor of the integral relationship catabolism/anabolism between energy streams in the body (F3). South Med J, 1984 Dec, 77(12), 1610 - 1 Primary meningococcal arthritis; Siebert WT et al.; We have reported a case of primary meningococcal arthritis of the left ankle in a previously healthy man . Although primary meningococcal arthritis clinically resembles gonococcal arthritis, prolonged antibiotic therapy and open joint drainage are often required . Even with prompt appropriate antibiotic and surgical therapy, primary meningococcal arthritis may lead to permanent joint damage. NIPH Ann, 1984 Dec, 7(2), 47 - 59 The virulence in mice of Neisseria meningitidis variants differing in free endotoxin activities and cell envelope properties; Andersen BM et al.; The virulence of two serogroup B meningococcal strains (270E+ and 840E+) having a high endotoxin release during in vitro growth, was compared with the virulence of corresponding variants (270E- and 840E-) liberating less endotoxin . The E-variants were isolated during subcultivations from the E+ strains . 270E+ and 840E+ were both serotype 15:P1.16, while 270E- was serotype 15:P1.2 and 840E- was non-typable . The SDS-PAGE patterns of the E+ and E- variants were also dissimilar . The E+ and E- variants differed in several other properties . Groups of mice were inoculated intravenously (i.v.) or intraperitoneally (i.p.) with E+ and E- meningococci . The endotoxin activities of inoculates and mouse blood were assayed by a Limulus lysate test . The mice received a similar infective dose of E+ and E- variants . A higher level of CFU and endotoxin was found in heart blood of E+ than of E-infected mice during the first hours after infection . Both 30h and 72h after inoculation, E+ variants were significantly more lethal to mice than E- variants (p less than 0.01). Carbohydr Res, 1984 Dec 1, 134(2), 229 - 43 Rate, mechanism, and immunochemical studies of lactonisation in serogroup B and C polysaccharides of Neisseria meningitidis; Lifely MR et al.; Meningococcal Serogroup B polysaccharide and colominic acid, which are (2----8)-alpha-linked homopolymers of sialic acid, undergo lactonisation at low pH at a rate which is dependent upon the molecular size and upon the salt form (Na+ or Ca2+) . Meningococcal Serogroup C polysaccharide, a (2----9)-alpha-linked homopolymer of sialic acid with acetyl groups present at O-7 and/or O-8, reacts with 1-ethyl-3-(3-dimethylaminopropyl)carbodiimide to give an O-acylisourea . The rate of formation of O-acylisourea does not differ substantially between O-acetylated (O-Ac+) C, non-O-acetylated (O-Ac-) C, and B polysaccharide . 13C-N.m.r . spectroscopy shows that, in the absence of O-acetyl groups, the majority of the activated carboxyl groups of C polysaccharide condense with an adjacent HO-8 to form a delta-lactone . Immunochemical studies show that the antigenicity of B polysaccharide is markedly reduced on lactonisation of less than 20%, as measured by a radioimmunoassay using an anti-B monoclonal antibody, and that low-molecular-weight colominic acid is poorly antigenic both before and after lactonisation, suggesting the presence of conformational determinants on B polysaccharide . In contrast, lactonisation and/or formation of O-acylisourea groups in the (O-Ac+)-C polysaccharide does not cause a significant decrease in the antigenicity, which is consistent with a sequential (structural) determinant on the molecule. Can J Microbiol, 1984 Dec, 30(12), 1453 - 7 Sulphur acquisition by Neisseria meningitidis; Port JL et al.; Group B Neisseria meningitidis (SD1C) was grown on defined medium supplemented with each of a variety of sulphur compounds as the sole source of sulphur . The organism grew on sulphate, sulphite, bisulphite, thiosulphate, dithionite, hydrosulphide, thiocyanate, L-cysteine, L-cystine, reduced glutathione, methionine, mercaptosuccinate, and lanthionine, but not on dithionate unless previously sulphur starved . Good growth was seen on concentrations of sulphate or thiosulphate as low as 10 microM . When pregrown on and subsequently starved for sulphate, the meningococcus showed enhanced transport capacity for this ion . Optimal conditions for assessing sulphur transport by active sulphur-limited cells were determined . The maximal sulphate uptake velocity was 9.3 nmol sulphate X mg protein-1 X min-1, and the apparent Km was 1.4 microM, far below human nasopharyngeal or serum sulphate levels. Br J Vener Dis, 1984 Dec, 60(6), 380 - 3 Comparison between bacampicillin and amoxycillin in treating genital and extragenital infection with Neisseria gonorrhoeae and pharyngeal infection with Neisseria meningitidis; Edwards LD et al.; Sixty three patients presumed to have genital gonorrhoea who gave histories of extragenital sexual practices were randomly treated with amoxycillin 3 g or bacampicillin 4.8 g (equivalent to 3.5 g ampicillin) with probenecid 1 g to compare the efficacy of the drugs in treating gonorrhoea at all sites . Three patients were initially culture negative, and seven failed to return for follow up . Twenty seven of 28 patients receiving bacampicillin and all 25 receiving amoxycillin gave negative genital cultures for Neisseria gonorrhoeae five to nine days after treatment . Twenty two of 60 patients had extragenital gonorrhoea . One failed to return, but all eight who had received amoxycillin and 12 of 13 who had received bacampicillin gave negative pharyngeal and anorectal cultures after treatment . N meningitidis was isolated from the pharynx in 17 of 60 patients on initial attendance . Three of 14 were still colonised with the meningococcus after treatment . Two of 32 patients receiving amoxycillin and 12 of 31 receiving bacampicillin reported experiencing gastrointestinal side effects. Crit Care Med, 1984 Dec, 12(12), 1021 - 3 Myocardial depression in septic shock caused by meningococcal infection; Monsalve F et al.; Comparative hemodynamic measurements recorded in 19 cases of septic shock associated with Neisseria meningitidis bacteremia and in 20 shock cases associated with bacteremia due to other Gram-negative bacilli showed a significantly higher incidence of early myocardial depression in the cases with meningococcal infection . Echocardiographic, ECG, and serum enzyme (CK-MB isoenzyme) studies closely correlated with impaired myocardial contractility and development of cardiogenic shock in patients with meningococcal bacteremia . Autopsy of the heart from three patients who succumbed to shock confirmed the presence of myocarditis with intracellular Gram-negative diplococci . Our observations suggest that the onset of cardiac dysfunction precedes clinical manifestations of shock. Infect Immun, 1984 Dec, 46(3), 673 - 6 Human opsonins to meningococci after vaccination; Halstensen A et al.; Two groups of volunteers were immunized with either a serogroup A plus C meningococcal polysaccharide vaccine or a combined serogroup B polysaccharide-serotype 2 protein vaccine . Serum opsonin responses were measured by chemiluminescence of polymorphonuclear leukocytes exposed to opsonized live meningococci . Two of the six volunteers immunized with the A plus C vaccine had an increase in serum opsonins to group A meningococci, four responded to group C meningococci, and none to group B meningococci . Five other volunteers who were immunized with the combined group B polysaccharide-serotype 2 protein vaccine responded with an increase in serum opsonins to group B meningococci of two different protein serotypes, as well as to a group C-serotype 2 meningococcal strain . Although no booster effect was observed after a second dose of the combined vaccine, both the polysaccharide and the protein components appear to be able to stimulate an opsonin response. S Afr Med J, 1984 Nov 17, 66(20), 759 - 62 Meningitis in Cape Town children; Potter PC et al.; A prospective clinical and microbiological survey of 213 children who presented to the teaching hospitals of the Cape Peninsula with meningitis was performed during a winter month . The predominant bacterium isolated was Neisseria meningitidis and this survey uncovered an outbreak of viral meningitis due to echovirus 4 of the Du Toit strain . In comparison with previous studies, the absence of fever in 20% of the cases of meningococcal disease and the isolation of N . meningitidis group B organisms which were resistant to sulphonamides are noted . Cases of N . meningitidis meningitis with initial clinical and cerebrospinal fluid findings indistinguishable from those in echovirus 4 meningitis are presented to emphasize the difficulties encountered in making a differential diagnosis . We recommend that in endemic areas all children with meningitis should be observed in hospital for at least 48 hours until the diagnosis of N . meningitidis has been excluded bacteriologically. Zh Mikrobiol Epidemiol Immunobiol, 1984 Nov, (11), 88 - 92 {Evaluation of the reactogenic and immunogenic properties of meningococcal vaccines}; Demina AA et al.; The results of the study of the reactogenic and immunogenic properties of meningococcal polysaccharide A + C vaccine in the controlled epidemiological trial, with regard to variations depending on the initial immunological characteristics of vaccinees in terms of the levels of antibodies to the polysaccharides contained in the vaccine, are presented . The study was made on school children: 303 of them were immunized with the meningococcal vaccine under test, and 229 (controls) with adsorbed diphtheria-tetanus toxoid . This study revealed that the reactogenic properties of the preparation were more pronounced in those children whose blood sera had been found to contain no antibodies to polysaccharides A and C prior to immunization . The immunological properties were more pronounced with respect to polysaccharide A . The titer of antibodies to polysaccharide A was found to depend on the previous immunological status of the child, which was indicative of the booster effect produced by the vaccine . The data obtained in the study suggest that the evaluation of the reactogenic and immunogenic properties of newly developed prophylactic preparations should be made with due regard for the previous immunological status of vaccinees in respect to the antigens contained in the meningococcal vaccine under test. Pediatr Infect Dis, 1984 Nov-Dec, 3(6), 523 - 5 Meningococcal group Y disease in children; Stephens DS et al.; Neisseria meningitidis Group Y has been considered to be an uncommon pathogen in children . We reviewed the cases of Group Y meningococcal disease in children managed at our institution from 1974 through 1982 . Twenty-four percent (6 of 25 cases) of the meningococcal disease in children between 5 and 20 years of age was caused by N . meningitidis Group Y . This serogroup of meningococcus was not isolated from children younger than 5 years of age . Meningococcemia characterized by purpura fulminans was the most common presentation . Pneumonia, a common presentation of Group Y meningococcal disease in military recruits, was not observed . Group Y meningococcal disease had emerged as a cause of meningococcemia and meningitis in older children and adolescents. Infect Immun, 1984 Nov, 46(2), 489 - 94 Inflammation triggers hypoferremia and de novo synthesis of serum transferrin and ceruloplasmin in mice; Beaumier DL et al.; Oil of turpentine was used to induce an artificial inflammation so that we could study its effect on iron metabolism and on synthesis of serum transferrin and ceruloplasmin in mice . It was found that turpentine-induced inflammation triggered the establishment of a hypoferremic state characterized by low levels of serum iron, followed by recovery and a gradual return to normal plasma iron levels . This turpentine-induced hypoferremia and its subsequent recovery paralleled the hypoferremia obtained during meningococcal infection . Moreover, serum transferrin and ceruloplasmin activity levels increased drastically during the recovery from hypoferremia . {14C}leucine incorporation studies revealed a de novo synthesis of both transferrin and ceruloplasmin . Turpentine-induced hypoferremia was also found to provide a protective effect against meningococcal infection which could be partially reversed by exogenous iron . The results of this study suggest that transferrin and ceruloplasmin may be synthesized partly in response to the altered iron metabolism observed during hypoferremia. Infect Immun, 1984 Nov, 46(2), 408 - 14 Development of a Neisseria meningitidis group B serotype 2b protein vaccine and evaluation in a mouse model; Wang LY et al.; Although serotype 2 remains the predominant cause of group B Neisseria meningitidis disease in many parts of the world, most cases of this disease are now due to serotype 2b rather than 2a . For this reason, we adapted the serotype 2a vaccine method of C . E . Frasch and M . S . Peppler (Infect . Immun . 37:271-280, 1982) to the production of a serotype 2b protein vaccine . A spontaneously occurring nonencapsulated mutant of the group B serotype 2b strain 3006 was obtained by selection on group B antiserum agar . Serotype 2b outer membrane protein vaccines were prepared with less than 1% lipoplysaccharide contamination . The immunogenicity of these vaccines was evaluated in mice in the presence and absence of meningococcal group B and group C capsular polysaccharides . The group B and group C polysaccharides equally potentiated the antibody response to the serotype 2b protein . Addition of aluminum hydroxide or aluminum phosphate markedly improved the antibody response to the serotype 2b protein, but aluminum hydroxide-adjuvanted vaccines consistently elicited higher antibody levels . Aluminum hydroxide-adsorbed serotype 2a and 2b protein vaccines were evaluated for induction of cross-protective bactericidal antibodies . The 2a vaccines were 2a specific, whereas the 2b vaccines elicited antibodies strongly bactericidal for both 2a and 2b meningococcal strains and protected against bacteremia in a mouse model . It may therefore be possible to provide protection against both 2a and 2b disease by using an aluminum hydroxide-adsorbed protein vaccine containing a single serotype 2 protein component. Infect Immun, 1984 Nov, 46(2), 507 - 13 Loss of pili and decreased attachment to human cells by Neisseria meningitidis and Neisseria gonorrhoeae exposed to subinhibitory concentrations of antibiotics; Stephens DS et al.; Recent evidence has suggested that surface structures of pathogenic bacteria, which are important in attachment to human mucosal surfaces, may be absent on bacteria grown in the presence of subinhibitory concentrations of antibiotics . We studied the effect of tetracycline and penicillin on meningococcal and gonococcal pili . Subinhibitory concentrations of tetracycline and penicillin were found to markedly reduce the number of pili per meningococcus or gonococcus and the percentage of meningococci or gonococci with pili, as determined by negative-staining electron microscopy . Sodium dodecyl sulfate-polyacrylamide gel electrophoresis of outer membrane preparations suggested that tetracycline decreased expression of pili by inhibiting synthesis of pilin subunits . In contrast, pilin subunit synthesis was unaltered by penicillin, suggesting a defect in assembly of pilin subunits or in anchoring of assembled pili . The decrease in the number of pili that occurred with subinhibitory concentrations of both tetracycline and penicillin was accompanied by a marked decrease in the ability of the organisms to attach to human cells . Gonococci or meningococci removed from the influence of subinhibitory concentrations of the antibiotics regained piliation, and attachment returned to levels near those of controls . The expression of meningococcal and gonococcal pili may be affected by factors that influence synthesis of pilin subunits or factors that interfere with the assembly and anchoring of pili in the outer membrane. J Infect Dis, 1984 Nov, 150(5), 672 - 7 Differentiation of B15 strains of Neisseria meningitidis by DNA restriction endonuclease fingerprinting; Kristiansen BE et al.; The restriction endonuclease fingerprinting technique was applied to meningococcal DNA in an attempt to identify individual strains of Neisseria meningitidis B15 (serogroup B, serotype 15), which causes approximately 90% of cases of meningococcal disease in northern Norway . Thirty representative strains (10 each from asymptomatic pharyngeal carriers, patients with septicemia, and patients with meningitis) were investigated with the restriction endonucleases Hind III and Eco RI . The 10 carrier strains showed a remarkable heterogeneity of fingerprints that rendered each strain easily distinguishable from the others . The 10 strains from the blood and the 10 from the cerebrospinal fluid showed similar but not identical restriction patterns . The results obtained with the two endonucleases were in perfect agreement . Our data suggest that a large number of different B15 clones are present in the population of northern Norway, but that only one single clone causes invasive meningococcal disease. Zh Mikrobiol Epidemiol Immunobiol, 1984 Nov, (11), 60 - 5 {Cross-reacting intraspecies antigens of Neisseria meningitidis . II . The dynamics of antimeningococcal antibodies to cross-reacting antigens in different forms of meningococcal infection}; Martynov IuV et al.; The presence of antibodies to meningococci has been determined in the sera of 203 patients with meningococcal infection and 234 healthy persons by means of the indirect hemagglutination tests with the use of polyvalent erythrocyte diagnosticum . The tests have shown that antibodies to cross-reacting antigens can be detected both in patients with generalized forms of meningococcal infection and in healthy persons; the level and occurrence of these antibodies depend on the age of the subjects under examination and the form taken by the course of meningococcal infection . The study has revealed that the background level of antibodies to meningococci in healthy persons is mainly formed due to meningococcal carriership . Antibodies to cross-reacting meningococcal antigens have been shown to be capable of being transferred transplacentally. Am J Med, 1984 Oct 19, 77(4C), 42 - 9 Rationale for clinical trials evaluating ceftriaxone in the therapy of bacterial meningitis; Scheld WM et al.; Ceftriaxone is a promising antimicrobial agent in the therapy of bacterial meningitis . The rationale for the clinical evaluation of ceftriaxone in patients with meningitis is based on the following favorable characteristics: ceftriaxone has excellent in vitro activity (MBC90 0.25 microgram/ml or less) against the major meningeal pathogens including meningococci, pneumococci, group B streptococci, Hemophilus influenzae, and Escherichia coli, but it is inactive against Listeria monocytogenes; ceftriaxone is rapidly bactericidal within purulent cerebrospinal fluid in experimental animal models of meningitis induced by pneumococci, group B streptococci, H . influenzae, and E . coli; against most of the major meningeal pathogens, the activity attained in cerebrospinal fluid in human subjects with bacterial meningitis is high (1:512 or greater) and active concentrations of ceftriaxone persist in cerebrospinal fluid for prolonged periods compared with those of other cephalosporins; the results of clinical trials reported to date in patients with meningitis are encouraging . Ceftriaxone deserves further clinical evaluation in the treatment of bacterial meningitis; the optimal dose, frequency of administration, and duration of therapy remain to be determined. Postgrad Med J, 1984 Oct, 60(708), 668 - 9 Meningococcal meningitis presenting with bilateral deafness and ataxia; Sandyk R et al.; A 50-year-old man presented with bilateral deafness and ataxia of sudden onset and without constitutional symptoms or signs of meningeal irritation . He was subsequently proved to have meningococcal meningitis, and the deafness and ataxia resolved following appropriate antibiotic therapy. J Pediatr, 1984 Oct, 105(4), 538 - 42 Myocardial dysfunction in children with acute meningococcemia; Boucek MM et al.; Acute meningococcemia is frequently associated with cardiovascular collapse of uncertain cause . Review of the records of 12 consecutive children revealed clinical evidence of myocardial dysfunction in six (50%) . Subsequently myocardial function was prospectively assessed clinically and echocardiographically in 12 children . Seven (58%) of the 12 children had echocardiographic evidence of myocardial dysfunction as defined by a depressed left ventricular shortening fraction (LVSF) . The mean LVSF in these seven children was 0.25 +/- 0.03, as compared with the mean LVSF of 0.39 +/- 0.7 in the remaining children . The LVSF estimate of myocardial function strongly correlated with cardiac output as measured by standard thermodilution (r = 0.98, P less than 0.01) . Acute meningococcemia was not fatal in those children without evidence of myocardial dysfunction . In contrast, three of the seven children with evidence of myocardial dysfunction died . In four children, echocardiographic evidence of left ventricular dysfunction preceded cardiovascular collapse and clinical recognition of myocardial dysfunction . In children with an initially low LVSF, recovery of LVSF was associated with survival . Children with acute meningococcemia may have impaired myocardial function as indicated by depressed LVSF, resulting in low cardiac output despite normal intravascular volume . Thus, in addition to restoring intravascular volume, knowledge of the status of myocardial function may help direct therapy toward optimizing myocardial contractility. Zh Mikrobiol Epidemiol Immunobiol, 1984 Oct, (10), 27 - 30 {Determination of meningococcal antibodies by a radial hemolysis method}; Martynov IuV et al.; The possibility of using, on principle, the reaction of radial hemolysis for the determination of antibodies to meningococci has been shown . The sensitivity and resolution of this method has been found to depend on the dose of the antigen used for the sensitization of erythrocytes, on the concentration of the erythrocyte suspension introduced into the gel and on the amount of complement . The optimum conditions for the reaction of optimum hemolysis, used for the determination of antibodies to serogroup A Neisseria meningitidis polysaccharide, have been established: the sensitizing dose of the antigen must be 50-100 micrograms/ml, the concentration of sensitized erythrocytes 25%, and the amount of complement 20-40 HU. Sex Transm Dis, 1984 Oct-Dec, 11(4), 296 - 300 In vitro inhibition of growth of Neisseria gonorrhoeae by Neisseria meningitidis isolated from the pharynx of homosexual men; Bisaillon JG et al.; Despite the high prevalence of pharyngeal gonorrhea and of meningococcal carriage among homosexual men, Neisseria gonorrhoeae and Neisseria meningitidis are rarely co-isolated from the throat . Forty-seven meningococcal isolates from the pharynx of homosexual men were examined, by a lawn-spotting method, for their ability to inhibit N . gonorrhoeae in vitro . Eight (17%) of the meningococcal isolates were inhibitory when tested against gonococci from the same patient, while 31 (66%) were inhibitory when tested against N . gonorrhoeae strain 650 (T1) . The colonial type T1 of a given strain was, in all cases tested, more sensitive to the inhibitory activities than the corresponding T4 type . Since the meningococci co-isolated from the throat with gonococci were at least as inhibitory in vitro as those isolated without gonococci, the natural resistance to gonococcal pharyngitis cannot be explained on the basis of the inhibitory activities produced by the meningococci in vitro . The inhibitory strains of N . meningitidis were identified in decreasing importance as: nonserogroupable, W135, C, B, 29E, and X . The addition of trypsin to the solid medium removed the inhibition produced by the meningococci, an observation suggesting the involvement of protein inhibitors. Acta Pathol Microbiol Immunol Scand {C}, 1984 Oct, 92(5), 247 - 54 Affinity chromatography for purification of antibodies to Neisseria gonorrhoeae and Neisseria meningitidis lipopolysaccharides; Rodahl E et al.; Lipopolysaccharides (LPSs) were prepared by phenol-water extraction of the gonococcal strain 8551 and the group B meningococcal strain 44/76, digested with pronase, and purified by ultracentrifugation and Sepharose CL-6B fractionation in the presence of 1.5 per cent sodium deoxycholate . On SDS-PAGE with 10 per cent acrylamide the purified 125I-labelled LPSs migrated as single, low-molecular-weight components . The LPSs were coupled to CNBr-activated Sepharose 4B for affinity purification of antibodies to the common antigenic factor 1 and the sero-type factor 5 of LPS 8551, and antibodies to LPS 44/76 . The antibodies eluted showed ELISA activity against wells coated with LPS or whole cells of the bacteria, the antibody activity being inhibited by LPS . SDS-PAGE of whole cells of the strain 8551 and immunoblotting with the anti-factor 1 or -factor 5 antibodies resulted in single, broad bands corresponding to the low-molecular-weight LPS subunits. Can J Microbiol, 1984 Oct, 30(10), 1289 - 91 Serotype distribution of meningococci isolated in South Australia 1971 through 1980; Ashton FE et al.; The serotypes of meningococci isolated from 76 sporadic cases of meningococcal disease in South Australia during the years 1971 through 1980 were determined . Thirty-four (56%) of the 61 group B strains were nontypable; the remainder were of five serotypes namely 8 (16%), 1 (13%), 2 (2a and 2b) (9%), 12 (3%), and 15 (3%) . Four of the five group B type 2 strains were serotype 2b . Serotype 2a accounted for four of seven group C strains and four of five group W135 strains . Overall serotypes 2 (2a and 2b) (17%), 8 (13%), and 1 (10%) occurred most frequently amongst the typable strains, whereas 40 (53%) of the 76 strains were nontypable . The results indicate that several serotypes and many nontypable strains were responsible for the sporadic disease occurring during a 10-year period in Australia. J Hyg (Lond), 1984 Oct, 93(2), 167 - 80 Meningococcal infections in Scotland 1972-82; Fallon RJ et al.; Strains of Neisseria meningitidis isolated from patients with meningitis or septicaemia without meningitis in Scotland during the years 1972-82 have been reviewed together with details of the age, sex, disease and outcome of the patients from whom they were isolated . A total of 1185 strains were isolated, of which 927 were examined at the Meningococcal Reference Laboratory (Scotland): 19.3% were of serogroup A, 63% of group B, 9.6% of group C, 6% of W135 and 1.6% of other groups . Non-groupable strains were rare . Disease was most common in the first years of life but there was a difference in the age distribution of disease due to the different serogroups, the proportion of disease due to group B being smaller in adults than that due to other serogroups . The overall mortality in meningitis was 7.5% and in septicaemia was 20.6%, although there were differences between the rates for the various serogroups . The serogroup distribution differed in disease as opposed to meningococci isolated from carriers although group B strains were predominant in both series . Overall, approximately 15% of strains were resistant to sulphadiazine, the proportion of resistant group A strains being higher than that of other serogroups. Eur J Clin Microbiol, 1984 Oct, 3(5), 439 - 41 Magnitude of bacteremia and complement activation during Neisseria meningitidis infection: study of two co-primary cases with different clinical presentations; Zwahlen A et al.; Two co-primary cases of schoolchildren with acute meningococcal disease due to infection with Neisseria meningitidis serogroup B are described . The first patient presented with septic shock and purpura fulminans, bacteremia greater than 10(5) organisms/ml blood, low C3 and factor B levels and an elevated level of C3d . The second patient had meningitis, negative blood cultures, normal levels of serum complement components but more than 10(4) organisms/ml in CSF . A comparison of the quantitative bacteriology data and complement profiles for these patients suggests that the degree of activation of complement during meningococcemia is directly related to the number of organisms in the blood . This association may determine the different clinical syndromes. J Clin Pathol, 1984 Oct, 37(10), 1123 - 8 Plasmids in throat and genital isolates of meningococci; Ison CA et al.; Plasmids 1.6, 2.8, or greater than 40 megadaltons in size were found in one urethral and nine throat strains of meningococci . Throat meningococci are known to be heterogeneous in their aminopeptidase profiles . Their unexpected content of plasmids is further evidence of their difference from classic systemic strains . Although the 2.8 megadalton plasmid has some resemblance to the well known 2.6 megadalton gonococcal plasmid, restriction enzyme studies gave no evidence of identity . Possible sources of the plasmids are discussed. J Clin Microbiol, 1984 Oct, 20(4), 672 - 6 Comparison of radioimmunoassay and enzyme-linked immunosorbent assay in measurement of antibodies to Neisseria meningitidis group A capsular polysaccharide; Beuvery EC et al.; Antibodies to meningococcal group A polysaccharide were determined by radioimmunoassay (RIA) and enzyme-linked immunosorbent assay (ELISA) in serum samples from 16 adults vaccinated with bivalent meningococcal group A and C polysaccharide vaccine . The specific antibody levels in the serum samples were expressed as micrograms of antibody protein per milliliter of serum . For RIA the polysaccharide was radiolabeled extrinsically with 125I . Both native polysaccharide and polysaccharide labeled with 127I were used in ELISA . Because these antigens gave similar results, it can be concluded that the introduction of tyramine and iodine by the labeling procedure did not alter the antigenic activity of the polysaccharide . The reproducibility of RIA was clearly better than that of ELISA . The antibody levels detected by the methods were equal, which means that ELISA can be used satisfactorily to measure antibodies to meningococcal group A polysaccharide quantitatively . Some discrepant results were found due to an underestimation of immunoglobulin M antibodies in ELISA . This was shown by a correlation test in which a weakly significant negative correlation was found between the immunoglobulin M antibody level/immunoglobulin G antibody level ratio and the RIA antibody level/ELISA antibody level ratio. South Med J, 1984 Oct, 77(10), 1234 - 9 Meningococcal meningitis in children: clinical comparison of disease produced by the minor and major serologic groups of Neisseria meningitidis; Ryan NJ et al.; Since 1972, there has been an increased incidence of meningococcal disease due to the minor serologic groups, "serogroups," of Neisseria meningitidis . Few cases, however, have been reported in pediatric patients . We present 24 cases of meningococcal meningitis, ten of them (42%) due to serogroups X, Y, and Z N meningitidis . We believe these cases to be the largest group of pediatric patients with such meningitis thus far reported . The clinical disease produced by the minor serogroups was indistinguishable from that produced by the major serogroups . Our experience supports previous published reports that severe meningococcal disease does occur with the minor serogroups of N meningitidis, and this increasing incidence may be of major importance if vaccination programs are to be effective in controlling epidemic meningococcal disease. Infect Immun, 1984 Oct, 46(1), 260 - 6 Monoclonal antibodies to serotype 2 and serotype 15 outer membrane proteins of Neisseria meningitidis and their use in serotyping; Zollinger WD et al.; A series of murine monoclonal antibodies to serotype 2 and serotype 15 strains of Neisseria meningitidis were produced which were specific for outer membrane proteins of classes 1, 2, 3, and 5 . A panel of eight monoclonal antibodies that exhibited a high degree of serotype specificity when reacted with prototype strains of known serotype were selected for study . Each of the corresponding epitopes was localized on a specific outer membrane protein by means of immunoprecipitation, electroblotting, or both . The serotype 2a-, 2b-, and 2c-specific antibodies bound to the class 2 protein, the serotype 15-specific antibody bound to the class 3 protein, two antibodies (3-1-P1.2 and 3-1-P1.16) bound to class 1 proteins, and two antibodies (1-1-P5.1 and 3-1-P5.2) bound to class 5 proteins . Six of these monoclonal antibodies were used in a spot-blot procedure to survey 122 case isolates (groups B, C, Y, and W135) and 363 carrier isolates (all serogroups) for the presence of the 2a, 2b, 2c, 15, P1.2, and P1.16 epitopes . A total of 66% of the case isolates and 30% of the carrier isolates reacted with one or more of the monoclonal antibodies . The use of monoclonal antibodies for serotyping of meningococci appears to be feasible and easy and appears to have significant advantages over the use of polyclonal typing sera. Zh Mikrobiol Epidemiol Immunobiol, 1984 Oct, (10), 99 - 102 {Immunoepidemiological characteristics of the duration of a meningococcal carrier state}; Deviatkina NP et al.; The duration of meningococcal carriership in children and adults in the foci of infection and outside such foci and the immunological characteristics relating to group-specific meningococcal antigens A, C, X, Y and Z at different periods after the detection of the infective agent in the nasopharynx have been studied . Carrier state has been shown to last, on the average, 11 days . The duration of the release of meningococci from the nasopharynx has proved to be influenced by the epidemic situation in a given group . Differences in the time course of the immunological reorganization of the body in response to antigenic challenge in prolonged and short-term carrier state have been detected . These data suggest that rapid immune response to meningococcal antigens in the process of short-term carrier state is probably one of the factors preventing the prolonged colonization of the nasopharynx by the infective agent. An Esp Pediatr, 1984 Sep 15, 21(3), 229 - 37 {Bacterial meningitis in children . Analysis of 181 cases}; Roman Pinana JM et al.; Clinical records of 181 children, aged between one month and seven years, admitted in a four year period, from 1978 through 1982, with the diagnosis of bacterial meningitis are revised . Peak incidence occurred in the age group between six months and three years, and during the months of January to May . N . meningitidis (35%), pneumococcus (4.9%) and H . influenzae (2.7%) were the most frequently isolated bacteria . CSF culture was negative in 56% of the children . All of them had previously taken antibiotics . Complications were present in 6.4%, with highest incidence in the known-agent group, on the following order: septic shock, 11%, seizures, 6.6%, and subdural effusion, 2.2% . Permanent sequelae were present in 3.8%, being deafness predominant . Twelve (6.3%) out of the 181 died, and death was result of fulminant meningococcal sepsis with endotoxic shock in ten of these patients . Clinical and psychological followed-up of twenty-nine children with isolated causal agent, were compared with a control group, finding no statistically-significant difference. S Afr Med J, 1984 Sep 1, 66(9), 345 - 6 Recurrent meningococcal meningitis . A case report; Hardcastle SW; A 17-year-old Coloured youth presented at Tygerberg Hospital on six occasions between 1978 and 1981 . He was admitted three times for meningococcal meningitis and three times for a meningitic illness clinically suggestive thereof . He had been admitted twice before to the City Hospital, Cape Town, in 1966 and 1968, for presumed meningococcal meningitis . He was fully evaluated in the outpatient department and found to have no detectable total haemolytic complement activity . There was no evidence of classic or alternative pathway activation . He has been tentatively designated as having a deficiency in the C6 or C8 components of the terminal membrane attack mechanism of the complement cascade. Rev Infect Dis, 1984 Sep-Oct, 6(5), 625 - 32 Primary meningococcal pericarditis: a disease of adults associated with serogroup C Neisseria meningitidis; Blaser MJ et al.; Pericarditis due to Neisseria meningitidis is usually a consequence of meningeal disease or meningococcemia . This presentation includes a case report of primary meningococcal pericarditis (PMP) and a review of the clinical and epidemiologic features of 15 previously reported cases . All cases have been reported in the past 15 years . Most patients were older teenagers or adults . The median age and age distribution of PMP cases in the United States were significantly greater than that of patients with other meningococcal diseases reported to the Centers for Disease Control (CDC) (P = .005) . Similarly, serogroup C N . meningitidis was isolated from 88% of U.S . patients with PMP, compared with isolation from 22% of patients with other meningococcal diseases reported to the CDC (P = .00016) . Culture of pericardial fluid usually yielded meningococci, and most patients presented with signs and symptoms typical of purulent pericarditis . A positive pericardial culture was associated with the development of cardiac tamponade (P = .03) . With appropriate antibiotic treatment and drainage of pericardial fluid when indicated, all 16 patients survived and experienced few or no sequelae. J Infect, 1984 Sep, 9(2), 197 - 202 Control of epidemic meningococcal meningitis by mass vaccination . II . Persistence of antibody four years after vaccination; Mohammed I et al.; Meningococcal antibody was measured in 928 persons vaccinated with combined groups A and C polysaccharide antigens in Bauchi State, Nigeria between 1979 and 1982 . Protective amounts of antibody were detected by the indirect haemagglutination technique up to 4 years after vaccination . This persistence was observed mainly in adults, although a substantial proportion of older children also had persistent antibody . Titres in younger children fell progressively, and by the third year the mean log2 antibody titre was 1.4; this may not confer protection against disease . A rational policy for vaccination against meningococcal meningitis would be to revaccinate younger children after 2 years, older children after 4 years, and adults after 6-8 or more years. J Infect, 1984 Sep, 9(2), 190 - 6 Control of epidemic meningococcal meningitis by mass vaccination . I . Further epidemiological evaluation of groups A and C vaccines in northern Nigeria; Mohammed I et al.; PIP: In mass vaccination campaigns organized by several state governments in northern Nigeria in 1978-81, a total of 7,535,350 people received bivalent groups A and C polysaccharide meningitis vaccines in the states of Bauchi, Borno, Gongola, and Plateau . This figure represents 53% of the population of these 4 states, which are part of the African meningitis belt . Of the total number of reported cases of meningitis from the 4 states in the 1978-81 period, 5565 (80%) occurred in 1978 . As more persons were vaccinated over the years, the number of reported cases declined significantly in all states but Gongola, where the percentage vaccinated (19%) was lowest . By 1980 in Bauchi, where 78% of the population had been vaccinated, there were only 12 reported cases of meningitis and no deaths, and there has not been a single reported case of the disease in this state since 1981 . These findings confirm the effectiveness of mass vaccination in limiting meningococcal infection . Moreover, mass vaccination has the potential of eradicating the disease, unlike selective vaccination . Epidemiologic research suggests it may be necessary to undertake mass vaccination campaigns only among those 3-15 years of age once every 4-5 years . J Infect, 1984 Sep, 9(2), 185 - 9 Validity of the recording of meningococcal disease according to various sources of information; De Wals P et al.; A study was made in Belgium in order to assess the completeness and specificity of the recording of meningococcal disease by routine sources of information . Ninety-three cases identified in a hospital survey were linked with those recorded in mortality statistics, in the notification of communicable diseases, and by the National Reference Laboratory for meningococci . Statistics based on mortality data appeared to be of low validity . The overall completeness of recording was 44% for the notification of communicable disease, and 40% for the reference laboratory . When these two sources were used for surveillance, the completeness of case-finding increased to 56% . When the analysis was restricted to bacteriologically-confirmed cases, the completeness of recording was 62% for the notification system, 70% for the laboratory, and 84% for both sources . The surveillance of communicable diseases should rely on various sources of information . Laboratory data should be systematically used in order to improve both the completeness of recording and the specificity of case-ascertainment. Medicine (Baltimore), 1984 Sep, 63(5), 243 - 73 Complement deficiency states and infection: epidemiology, pathogenesis and consequences of neisserial and other infections in an immune deficiency; Ross SC et al.; Inherited deficiencies of the complement proteins are rare in unselected populations . Examination of patients with the clinical correlates of complement deficiency (autoimmune disease and certain bacterial infections) shows the frequency of inherited complement deficiency to rise enormously (5.9% of patients with systemic lupus erythematosus, 10 to 25% of adults with sporadic meningococcal disease) . Autoimmune diseases of all types, but especially systemic lupus erythematosus, discoid lupus and glomerulonephritis, are seen in all categories of complement deficiency, most typically in those of the early classical pathway (C1, C4, C2) . Pneumococcal infections are characteristic of deficiencies of the early classical pathway, as well . Deficiencies of C3 are associated with severe disease including autoimmune phenomena, pneumococcal and neisserial infections . C3-deficient patients become ill substantially earlier in life . Infections with N . meningitidis and N . gonorrhoeae are most typical of the late component deficiencies, with over 40% of homozygotes affected . Despite the presence of this deficiency from birth and the peak age-specific incidence of meningococcal disease in the general population at ages 3-8 months, the median age of first infection in the late component-deficient patients is 17 years . Relapse of infection is ten times more common in these patients, and discrete recurrences are seen in 45% of affected individuals . An unusual and unexplained predilection for infection with serogroup Y N . meningitidis exists . Despite an immune deficiency, and problems with ascertainment bias, it appears that persons with late component complement deficiency enjoy less mortality than normals who contract meningococcal disease . Attempts to explain the pathogenesis of neisserial infection in late component deficiencies have focused on the concept that normally non-pathogenic serum-sensitive bacteria are etiologic in the absence of serum bactericidal activity . Data to support this concept remain to be developed and contrary data exist . A separate mechanism may predispose properdin-deficient patients to meningococcal infection, since they appear to develop fulminant infections with high mortality. Infect Immun, 1984 Sep, 45(3), 544 - 9 Heterogeneity of molecular size and antigenic expression within lipooligosaccharides of individual strains of Neisseria gonorrhoeae and Neisseria meningitidis; Schneider H et al.; We determined the Mr of neisserial lipooligosaccharides (LOS) by using discontinuous sodium dodecyl sulfate-polyacrylamide gel electrophoresis, minimal loading concentrations, and Salmonella isogenic rough mutant LOS as Mr standards . Salmonella LOS were resolved into three components . The migration distance of each component was linearly related to its theoretical Mr (r = 0.99) . Neisserial LOS also contained multiple components whose calculated Mr ranged from 3,200 to 7,100 . The relative abundance of components and their MrS varied greatly among strains . Meningococcal LOS were composed almost exclusively of two closely migrating components; gonococcal LOS were more heterogeneous . LOS from a gonococcus selected for resistance to a Pseudomonas pyocin contained only a single component that was different from and of intermediate Mr among the three components of the parent strain . A monoclonal antibody directed against the meningococcal L8 LOS epitope was used to determine whether heterogeneity of antigen expression reflected Mr heterogeneity . Single components of the L8 meningococcal LOS and of the LOS of 3 of 19 gonococcal strains bound the monoclonal antibody . Gonococcal LOS components that expressed the L8 epitope were of a similar Mr (4,800) . Smaller components of these same LOS did not express the epitope. Zh Mikrobiol Epidemiol Immunobiol, 1984 Sep, (9), 32 - 7 {Cross-reacting intraspecific antigens of Neisseria meningitidis . I . The isolation, immunochemical and serological characteristics of the cross-reacting antigens of N . meningitidis serogroup A}; Gracheva AM et al.; New data on the cross-reacting antigen of N . meningitidis, serogroup A, are presented . A complex of antigens has been isolated by treatment with tryptone X-100, ethanol precipitation and the subsequent treatment with trichloroacetic acid . The immunological analysis of the isolated preparation has shown that the proteinaceous part of the biopolymer contains 7 polypeptide fragments; of these, one fragment with a molecular weight of 31000 daltons has been found to constitute 49, 15% of all polypeptide fragments . The evaluation of the serological properties of this preparation in the precipitation test and the passive hemagglutination test has revealed that the preparation contains various cross-reactive antigenic determinants . Polyvalent erythrocyte diagnosticum obtained on the basis of this preparation permits the detection of antibodies to meningococci irrespective of their serogroup. Rev Infect Dis, 1984 Sep-Oct, 6(5), 640 - 8 Group A meningococcal disease in the U.S . Pacific Northwest: epidemiology, clinical features, and effect of a vaccination control program; Counts GW et al.; In 1975 an outbreak of group A meningococcal disease began in Seattle, Washington, and cases subsequently were recognized throughout the Pacific Northwest . Nearly one-half of the affected persons were Native Americans; two-thirds were alcohol abusers and/or habitues of skid road communities . In Seattle, group A meningococci colonized asymptomatic persons only if these individuals had contact with skid road (P = .006) . The epidemic strain may have spread from American Indians in Manitoba, Canada . Traditional migration routes connect the two populations; asymptomatic American Indians on reservations in Washington carried group A meningococci . Vaccination programs were undertaken in four cities but only after cases occurred . In Seattle, vaccination reached 80% of the target population and was associated with a significant decrease in incidence of the disease, but cases recurred after the program ended . The social habits of skid road communities, combined with the "case-triggering" approach to, and premature termination of, vaccination programs, may have resulted in 56% of regional cases occurring after the start of the vaccination program in Seattle. J Infect Dis, 1984 Sep, 150(3), 436 - 49 Reexamination of the protective role of the capsular polysaccharide (Vi antigen) of Salmonella typhi; Robbins JD et al.; The role of the Vi antigen, the capsular polysaccharide of Salmonella typhi, in the pathogenesis of and immunity to typhoid fever remains the subject of controversy . Vi-positive S . typhi resist phagocytosis and the action of serum complement, both of which actions are initiated by antibodies to Vi antigen . Both the laboratory potency in mice and the clinical effectiveness of whole-cell vaccines were related to their content of immunogenic Vi antigen . A Vi polysaccharide used for immunizing humans against experimental challenge with S . typhi failed to prevent typhoid fever; experimental conditions used to prepare this ineffective Vi antigen were shown to denature it and to reduce its immunogenicity . Assay of serum antibodies to Vi antigen with purified Vi antigen is a reliable method for diagnosis of typhoid fever and asymptomatic carriage of S . typhi . Vi polysaccharides prepared by modern techniques passed the requirements for meningococcal polysaccharide vaccines and had approximately 13 times the protective activity in the mouse potency assay as did the US Standard 6A whole-cell typhoid vaccine. S Afr Med J, 1984 Aug 25, 66(8), 308 - 9 Neisseria flavescens septicaemia with meningitis . A case report; Coovadia YM; A rare case of septicaemia with meningitis caused by Neisseria flavescens is reported . The clinical presentation and initial bacteriological findings were indistinguishable from those in meningococcal septicaemia with purpura . A review of the literature for N . flavescens infections revealed 15 other cases of meningitis and 1 of septicaemia . A plea is made for the full identification of all Neisseria isolated, especially those isolated from cerebrospinal fluid and blood cultures, so that closely related members of the family Neisseriaceae are not confused. Can J Microbiol, 1984 Aug, 30(8), 1042 - 5 Experimental meningococcal infection in neonatal mice: differences in virulence between strains isolated from human cases and carriers; Salit IE et al.; The lack of availability of a suitable animal model has limited understanding of the pathophysiology of meningococcal disease . We have utilized a neonatal mouse model in which atraumatic intranasal inoculation of meningococci results in nasopharyngeal colonization and ultimately bacteremia . Using this model, we compared the virulence of seven encapsulated meningococcal carrier strains with eight meningococcal strains which were isolated from cerebrospinal fluid or blood of patients (disease strains) . Intraperitoneal (IP) iron dextran was given to some animals to enhance meningococcal virulence . After IP iron, carrier strains were still poorly invasive with rates of bacteremia ranging from 0 to 15% (mean = 3%), whereas disease-associated strains were significantly more invasive and caused bacteremia in 31-64% of animals (mean = 39%) . Without iron injections, nasopharyngeal colonization rates were similar (36 versus 30%, P greater than 0.1) for case and carrier strains . IP iron dextran significantly enhanced rates of colonization and bacteremia caused by the disease strains only . We have, therefore, shown that the relative virulence of meningococcal strains for humans is maintained in this experimental model. Can J Microbiol, 1984 Aug, 30(8), 1022 - 9 Experimental meningococcal infection in neonatal animals: models for mucosal invasiveness; Salit IE et al.; A more complete understanding of meningococcal disease has been hampered by lack of an appropriate animal model . We subjected 5-day-old guinea pigs, rats, and mice to intranasal challenge with meningococci and we measured rates of bacteremia as a marker of mucosal invasion . After a single intranasal instillation of 10(7) serotype 2 meningococci, positive blood cultures were found in 0% of guinea pigs, 16% of rats, and 39% of mice, and so mice were used for further studies . Death occurred in 4% of mice and was associated with a purulent leptomeningitis and ventriculitis . Forty percent of mice had nasopharyngeal colonization which increased to 65% with repeated injections . Carrier strains were avirulent, a nonserotype 2 disease strain had low invasiveness, and serotype 2 strains were most virulent . Iron dextran increased rates of bacteremia after challenge with serotype 2 strains . Adult animals were not susceptible to bacteremia after intranasal challenge . The neonatal mouse model fulfills most of the criteria for an appropriate experimental model of meningococcal disease. J Clin Microbiol, 1984 Aug, 20(2), 255 - 8 Filter radioimmunoassay, a method for large-scale serotyping of Neisseria meningitidis; de Marie S et al.; A simple and rapid filter radioimmunoassay method can be used to serotype meningococcal strains on a large scale . The technique consists of simultaneous inoculation of 96 strains on nitrocellulose filters . The resulting colonies can be processed in situ, by extraction and fixation, incubation with antibodies and 125I-labeled protein A, and, finally, autoradiography . Processing many filters simultaneously, one person can serotype thousands of meningococci in a week . Multiple filters with identical strain patterns can be stored after the fixation step for future screening . The use of monoclonal antibodies is essential; polyclonal antisera, even after extensive absorption, were not specific in this assay . When results from filter radioimmunoassay and Ouchterlony microprecipitation were compared for the serotyping of 201 Neisseria meningitidis strains for serotypes 2a and 2b, filter radioimmunoassay was sufficiently sensitive and specific to be useful in mass screening. Zh Mikrobiol Epidemiol Immunobiol, 1984 Aug, (8), 72 - 6 {Comparative study of the sensitivity and specificity of dried and liquid meningococcal erythrocyte diagnostic agents A, C and Y in a controlled trial}; Nikitiuk NM et al.; The comparative study of the sensitivity and specificity of dried and liquid meningococcal erythrocyte diagnosticums A, C and Y has been carried out in the indirect hemagglutination test with the sera of persons immunized with different doses of dried chemical meningococcal (group A) polysaccharide vaccine and persons receiving placebo under the conditions of a controlled epidemiological trial . The possibility of using, on principle, both liquid (A, C) and dried (A, C, Y) preparations in clinico-epidemiological studies has been established . The continuation of the research work aimed at the improvement of meningococcal diagnosticums and, in particular, at the development of polyvalent preparations seems to be justified. Zh Mikrobiol Epidemiol Immunobiol, 1984 Aug, (8), 52 - 5 {Serotypes of meningococci isolated in the USSR and the Republic of Cuba}; Demina AA et al.; The results of serotyping of 101 meningococcal strains isolated in the Soviet Union and 23 strains isolated in the Republic of Cuba are presented . Typing within groups was carried out by Frasch's method in the double diffusion test in gel . For this purpose serotype antigens were prepared from each strain . These antigens were used in the test only after their purification by ultracentrifugation . In all cases the prevalence of serotype 2 was revealed . A great number of Cuban strains contained a wide spectrum of type antigens of both protein and lipopolysaccharide nature . Serotype antigen 15 occurred in meningococci isolated both in the USSR and in Cuba . In most cases type 15 occurred in combination with types 2 and 8 . The comparison of the results obtained in the serotyping of meningococci isolated in situations, nonepidemic (USSR) and epidemic (Cuba) for serogroup B, gives no grounds for considering type 2 as the "marker of virulence" . Probably, this problem will be solved by the differentiation of subtypes within type 2 . Attention should be paid to the serotype antigens of the lipopolysaccharide nature with a view to their epidemiological evaluation. Zh Mikrobiol Epidemiol Immunobiol, 1984 Aug, (8), 44 - 7 {Characteristics of nonpathogenic Neisseria and Branhamella catarrhalis based on cytopathogenicity}; Galeeva OP et al.; The study of the action of 12 Neisseria species belonging to 112 strains, 6 B . catarrhalis strains and 202 meningococcal strains on the culture of continuous cell line F1 (human amniotic cells) has revealed that nonpathogenic Neisseria are essentially weaker than meningococci in their pathogenicity (expressed in terms of CPD50) . Among nonpathogenic Neisseria highly cytopathogenic strains occur in 13.9% of cases, which gives grounds for considering them opportunistic bacteria . Sharply pronounced correlation between the adhesive and pathogenic properties of Neisseria has been observed . The cytopathogenic action of Neisseria is accompanied by the lesion of the chromosomal apparatus of mitotic infected cells. Zh Mikrobiol Epidemiol Immunobiol, 1984 Aug, (8), 110 - 4 {Specific immunological reactivity in generalized forms of meningococcal infection in children}; Korzhueva NA et al.; The characteristics of immune responsiveness were studied in 455 children aged 2 months to 14 years with the generalized forms of meningococcal infection . In children of all age groups an increase in the titers of antibodies to meningococci was revealed; this increase started from day 4 of the disease, reached its maximum at the end of week 3 or the beginning of week 4 and correlated with the severity of the disease and the age of the patients . A drop in the IgG level in the course of the disease and a rise in the IgM level by the end of week 2 were observed . A decrease in the content of T-lymphocytes at the acute period of the disease and an increase in the number of B-lymphocytes, especially by the end of week 2 of the disease, were established. Arch Intern Med, 1984 Jul, 144(7), 1481 - 2 Recurrent Neisseria meningitidis bacteremia . Association with deficiency of the eighth component of complement (C8) in a Sephardic Jewish family; Zimran A et al.; A 24-year-old man had repeated episodes of meningococcal meningitis . Selective deficiency of the eighth component of complement (C8) was demonstrated in the patient, his twin brother, and in one of five siblings . As the parents were first cousins of normal phenotype, this pattern is suggestive of an autosomal recessive heredity . The present report brings the total number of patients given the diagnosis of C8 deficiency to 14, and calls attention to the existence of this condition in Jews of Sephardic (Mediterranean) origin. Am J Clin Pathol, 1984 Jul, 82(1), 97 - 9 Evaluation of the Directigen and Phadebact agglutination tests; McGraw TP et al.; Comparison testing of the Directigen latex agglutination (LA) kit, the Phadebact coagglutination (COA) kit, and counter-immunoelectrophoresis (CIE) demonstrated that the commercial LA reagents were slightly more sensitive than the COA reagents for the detection of pneumococcal polysaccharide types 2, 4, 8, 9, 12, 19, 23, 25, 51, and 56, and meningococcal polysaccharide from Group C . The COA reagents were slightly more sensitive than the LA reagents for the detection of pneumococcal polysaccharide type 6A . The sensitivity of LA and COA reagents for the detection of Hemophilus influenzae type b capsular polysaccharide, pneumococcal polysaccharide types 1, 3, 14, and meningococcal Group A were equivalent . Purified meningococcal polysaccharides of Groups B, C, and W135 were detected uniformly by CIE but not with the COA reagent . The COA reagent reacted with antigen of Groups B, C, and W135 from broth culture but with less sensitivity than CIE . In general, CIE was the least sensitive method for detecting bacterial antigens . In addition, the commercial CIE antisera for H . influenzae type b, or meningococcal polysaccharides were susceptible to false-negative results due to antigen excess. J Biol Stand, 1984 Jul, 12(3), 241 - 6 Molecular sizing of individual polysaccharides in polyvalent pneumococcal and meningococcal vaccines by column chromatography and immunoelectrophoresis; Scheers R et al.; We determined the molecular size of meningococcal and pneumococcal polysaccharides in final vaccines, using a combination of column chromatography and simple rocket immunoelectrophoresis . We found a good correlation between the distribution coefficients obtained with UV monitoring or ELISA and immunoelectrophoresis. South Med J, 1984 Jul, 77(7), 824 - 6 Indolent meningococcal meningitis: a cautionary tale; Simon HB et al.; Bacterial meningitis is a medical emergency that is ordinarily rapidly progressive . We present three patients who had meningococcal meningitis with an indolent course . Symptoms were present from two days to four weeks before hospitalization . Cerebrospinal fluid cultures grew Neisseria meningitidis one to eight days before antibiotic therapy, yet all patients remained fully alert and clinically stable during this interval . All recovered after penicillin therapy . In the future earlier diagnosis should be facilitated by an awareness of differing manifestations of meningococcal meningitis, including benign CSF findings, intact sensorium, and an indolent progression . Immunologic studies will be required to clarify the pathogenesis of this syndrome. J Clin Microbiol, 1984 Jul, 20(1), 1 - 4 Superoxol and amylase inhibition tests for distinguishing gonococcal and nongonococcal cultures growing on selective media; Arko RJ et al.; Two inexpensive screening tests were evaluated singly and in tandem for distinguishing Neisseria gonorrhoeae from other oxidase-positive microorganisms growing on selective gonococcal media . In tests of 728 cultures, including 460 N . gonorrhoeae, 4 Neisseria lactamica, 257 Neisseria meningitidis, and 7 Branhamella catarrhalis, both Superoxol (30% H2O2; J . T . Baker Chemical Co., Phillipsburg, N.J.) and amylase inhibition tests were 100% sensitive (positive) for 20-h cultures of N . gonorrhoeae . Singly, the Superoxol test was 92.7% specific for N . gonorrhoeae, compared with a specificity of 82.3% for the amylase inhibition test . By using tandem screening tests to distinguish gonococci, we achieved an overall specificity of 98.6% . Group A meningococci were the primary source of error in the Superoxol test, with 97% (37 of 38) strains producing gonococcal like reactions for catalase . From 5 to 20% of N . meningitidis serogroups X, Y, Z, and Z' and nontypable strains, as well as about 50% of B . catarrhalis and N . lactamica strains, were also strong catalase producers. J Clin Microbiol, 1984 Jul, 20(1), 40 - 2 Neutralization of the inhibitory effect of sodium polyanetholesulfonate on Neisseria meningitidis in blood cultures processed with the Du Pont Isolator System; Scribner RK et al.; The inhibitory and bactericidal effects of sodium polyanetholesulfonate on Neisseria meningitidis were neutralized by blood lysis which occurs within the pediatric Isolator 1.5 Microbial tube (E . I . du Pont de Nemours & Co., Inc., Wilmington, Del.) . Lysed blood was more effective than 2.5% gelatin in preventing the inhibitory effect . All but 1 of 16 N . meningitidis strains were killed by 0.06% sodium polyanetholesulfonate in the absence of lysed blood, whereas none were killed by 1.0% sodium polyanetholesulfonate when lysed blood was present . The possible clinical relevance of these results was reflected in the improved detection of meningococcemia in children when the Isolator 1.5 Microbial tube was compared with a conventional broth system. Lancet, 1984 Jun 16, 1(8390), 1339 - 42 Meningococcal disease and season in sub-Saharan Africa; Greenwood BM et al.; The incidence of meningococcal disease varies seasonally in both tropical and temperate countries . This association is most apparent in sub- Saharan Africa, where almost all epidemics start in the dry season and abate during the rains . Meningococcal carriage rates do not vary with season either in Africa or in temperate countries, suggesting that seasonal factors have little influence on the frequency of meningococcal transmission . It is suggested that changes in the ratio of clinical to subclinical cases of infection are more important than changes in the frequency of transmission in producing seasonal variations in the incidence of meningococcal disease . Some evidence to support this hypothesis was obtained during an epidemic of group A meningococcal disease in northern Nigeria in 1977-79. J Neurosurg Nurs, 1984 Jun, 16(3), 134 - 9 Meningococcemia: a case report; Galanes S; Meningococci in their pathogenic state can result in meningitis and/or meningococcemia . Fulminant meningococcemia has a high fatality rate and encompasses multiple complications which occur concurrently . Only with immediate and intensive care treatment can there be any hope of survival . Even with survival of the disease, the resulting complications and treatments can be overwhelming . The case report clearly demonstrates the extensiveness of the disease, but also displays a positive outcome in this particular case. NIPH Ann, 1984 Jun, 7(1), 3 - 11 Late sequelae after meningococcal disease . A controlled study in young men; Sander J et al.; The occurrence of sequelae 3-15 years after meningococcal disease has been investigated in a study on 71 patients and 64 controls . The patients were young men, aged 18 to 24 years at the time the disease was contracted . Participants filled in a questionnaire on possible symptoms . Audiometry and EEG were also carried out . The response rates were 84% among patients and 75% among controls . We found that 61% of the patients had one or more symptoms of possible sequelae compared to 20% in the control group (p less than 0.001) . The symptoms were generally light and of mental or neurological type . Among the patients 13% stated that they had obvious complaints commonly attributed to meningococcal disease, compared to 2% only in the controls (p less than 0.05) . Twenty-nine per cent of the patients stated that the disease had affected their education or working capacity . No statistical differences between patients and controls were demonstrated by audiological or EEG examinations . In only one single ear could deafness unequivocally be attributed to the disease. Ann Trop Med Parasitol, 1984 Jun, 78(3), 265 - 71 Malumfashi Endemic Diseases Research Project, XXI . Pointers to causes of death in the Malumfashi area, northern Nigeria; Bradley AK et al.; For 228 of 425 deaths (54%) occurring among 26 100 people of known age in the Malumfashi area of northern Nigeria, data were collected on symptoms present prior to death . Information was obtained on monthly registration visits, as part of demographic investigations, and data for the period November 1977-October 1978 have been analysed . Enumerators used a carefully prepared list of 25 symptoms to elicit information from relatives of the deceased . Pyrexia, diarrhoea and measles accounted for 77% of all deaths . Epidemiological determinants were responsible for all cases of meningococcal infections in the dry season and most cases of diarrhoea in the wet season . Most deaths attributed to measles occurred in the late dry season and early wet season . Epidemics of measles seemed to be localized at any one time in certain villages and the micro-epidemiology of this feature is considered . Malaria does not appear to be responsible for all deaths from pyrexia in the nought to four age group. Acta Pathol Microbiol Immunol Scand {B}, 1984 Jun, 92(3), 159 - 63 Inhibitory spectrum of bacteriocin-like agents from Neisseria meningitidis; Jyssum K et al.; Bacteriocin-like agents from five strains of Neisseria meningitidis were active against other meningococci and some other Neisseria species . Meningococci belonging to the same serogroup or serotype could be subdivided into distinct bacteriocin types . Insensitivity to the inhibitory agents was observed more frequently among serologically groupable strains than among non-groupable . Strains belonging to serogroup B were more often insensitive to the inhibitors released by four of the donor strains (P201, P213, P241, 99/79) than other groupable strains . Insensitivity to the bacteriocin-like activity of the fifth donor strain (77/79A) seemed to be evenly distributed among strains of different groups . Strains of serotype 15 were more often insensitive to the five inhibitors than strains belonging to other types . Group B and type 15 are most frequently observed among strains isolated from clinical cases in Norway. Zh Mikrobiol Epidemiol Immunobiol, 1984 Jun, (6), 31 - 5 {Natural reproduction of all stages of a generalized meningococcal infection in mice}; Mironova TK et al.; The present work is based on the direct relationship, revealed in our investigations, between the hyaluronidase activity of meningococcal strains and their capacity to penetrate into the blood and the liquor . The use of the intranasal route (i.e . the natural route) for infecting previously untreated mice with meningococci in the presence of hyaluronidase made it possible to follow the generalized form of meningococcal infection in all its stages from the period of incubation and microbial invasion to bacteriemia, accompanied by the penetration of the infective agent into the meninges, and toxinemia . This route of infection ensured the penetration of the infective agent, but the natural specific resistance of mice to meningococci prevented their multiplication with the subsequent liberation of a sufficient amount of endotoxin killing the animals . To overcome natural immunity and increase toxicity, actinomycin D was injected intraperitoneally in a volume of 0.5 ml (5 gamma) simultaneously with the administration of the microbial culture and hyaluronidase, thus ensuring 40-60% mortality among the animals . Our model of the generalized form of meningococcal infection can be used in the study of pathogenesis and for the development of the methods of treatment and microbiological diagnosis. Pathol Biol (Paris), 1984 Jun, 32(5 Pt 2), 532 - 5 {Antibiotic sensitivity of meningococci isolated from patients and carriers}; Dabernat H et al.; Ninety-two strains of Neisseria meningitidis (twenty-four recovered from CSF, four from blood, and sixty-four from oropharyngeal swabs) were tested for susceptibility to penicillin, ampicillin, minocycline, chloramphenicol, rifampicin, erythromycin, spiramycin, josamycin, sulphamethoxazole, and trimethoprim . Antibiotic activity (MIC) was determined by agar dilution . Among the 92 cultures, strains were in the following decreasing order: group B, undefined groups, and group C . 75% of